2026-10-21 · Original Research
Deanna Kerrigan, Wendy Davis, Allison O’Rourke, Noya Galai, Andrea Mantsios, Rachel K. Scott, Patricia Moriarty, Aimee A. Metzner, Alan Oglesby, Tahilin Sanchez Karver, Tamara Taggart, Clare Barrington, Breana J. Uhrig Castonguay, Kimi Yonamine, Hoisex Gomez, Martha Perez, Yeycy Donastorg
IntroductionSignificant inequities in HIV incidence and prevalence exist among cisgender women (hereafter women), including a disproportionate burden of the epidemic among Black women in the United States and female sex workers globally. Women have limited awareness of and access to pre–exposure prophylaxis (PrEP) for HIV pharmacoprevention.MethodsWe explored PrEP awareness, interest, and modality preferences [daily oral vs. long–acting injectable (LAI) PrEP] in Santo Domingo, Dominican Republic (DR) and Washington, DC (DC) in the United States through in–depth interviews (IDIs) with women (N = 40) and healthcare providers (HCPs; N = 20) in 2021–2022 and surveys of women (N = 602) in 2022–2023. Thematic analysis andmultivariate regression were utilized.ResultsAcross settings, women were aged ≥18 years and HIV–negative; most were Black or multiracial, single, in their 30s, with >1 child. In IDIs, women characterized PrEP as an empowerment tool and welcomed modality options; HCPs across sites relayed a lack of comfort and preparation to address the unique needs of women and discuss LAI PrEP. In surveys, women reported low PrEP awareness and use: 29% (DC) and 6% (DR) had heard of daily oral PrEP, <6% had heard of LAI PrEP across sites, and 3% (DC) and 1% (DR) had ever used PrEP. Strong interest in taking PrEP varied (DC, 5%; DR, 80%). Modality preferences were similar, with most preferring LAI vs. daily oral PrEP (DC, 73%; DR, 71%). Across sites, preference for LAI PrEP was inversely associated with concern for injection pain/tenderness. In DC, LAI preference was associated with a higher score on a PrEP optimization/ considerations scale. In the DR, LAI preference was associated with injectable medication/contraception experience and alcohol use and inversely associated with PrEP stigma and partner violence.DiscussionDiverse groups of women have shared and unique drivers of PrEP modality preferences which should be considered when developing and tailoring multi–level interventions to promote PrEP awareness and uptake among women. These interventions should address social determinants and side effects and include HCP training and tools that promote shared decision–making.
DOI: 10.3389/fgwh.2026.18174112026-10-21 · Original Research
Melba Sheila D’Souza, Aishwarya Manish, Hannah Nette, Juanita-Dawne R Bacsu
BackgroundBreast cancer remains the most frequently diagnosed cancer worldwide, with rising incidence rates in British Columbia (BC), Canada. While survival rates have improved, the psychosocial burden of survivorship is significant. The study aimed to examine the lived experiences of psychosocial outcomes and quality of life of adults newly diagnosed with breast cancer in interior British Columbia.MethodsAn explorative-descriptive qualitative research design was used. A purposive sampling was used to recruit participants who had received a diagnosis of breast cancer. Interviews were conducted with 28 participants from April 2023 to April 2024. Data were transcribed and analyzed using directed qualitative content analysis in NVivo 14 software.ResultsContent analysis revealed three main categories: a) transitional care: need for mentorship, connection and advocacy; b) quality of life: psychological, emotional, and financial distress; and c) interpersonal relationships: body identity, sexuality, and dysmorphiaConclusionsAs the population continues to age, insights into psychological outcomes and challenges experienced by newly diagnosed adults with breast cancer are increasingly necessary for evidence-informed knowledge and care recommendations. Healthcare professionals adopting a shared team-based, equity-oriented care approach helps to address social, financial, and physiological needs.
DOI: 10.3389/fgwh.2026.18286242026-10-21 · Original Research
Mayadhar Sethy
BackgroundStagnant government health expenditure (GHE) and declining development assistance for health (DAH) threaten universal health coverage (UHC) for women in low-income countries (LICs) and lower-middle-income countries (LMICs). Women's health financing remains under-resourced and vulnerable to fiscal austerity, debt distress, and donor withdrawal. This study quantifies the crowding-out effect of debt service on government expenditure for women's health (GHEW) and estimates the probability of closing women-specific UHC financing gaps under alternative donor withdrawal scenarios.MethodsA balanced panel of 71 countries (32 LICs and 39 LMICs), comprising 497 country-years from 2018 to 2025, was constructed using WHO, IMF, World Bank, OECD, IHME, and DHS data. A fixed-effects instrumental-variable model estimated determinants of GHEW using lagged GHE and donor-alignment instruments (first-stage F = 41.2). A Cox survival model projected the probability of closing women's UHC financing gaps by 2030, defined as combined spending reaching ≥80% of sex-disaggregated benchmarks (US$62 for LICs and US$95 for LMICs). Projections incorporated announced donor reductions with probabilistic scenarios. Validation included out-of-sample forecasting, placebo tests, and patient-level DHS validation.FindingsMedian combined LIC spending increased only marginally, from US$15.90 in 2018 to US$16.40 in 2025. Each 1-percentage-point increase in debt service as a share of GDP reduced GHEW by 4.2% (β=−0.042, p < 0.001), significantly exceeding its effect on general health expenditure (β=−0.012, p = 0.032; difference p = 0.008). Under baseline projections, no LIC and 23.1% of LMICs were projected to close women's UHC financing gaps by 2030. Each 1% decline in DAH reduced gap-closure probability by 6.1% (HR = 0.939, p = 0.002), whereas fiscal-space expansion nearly tripled closure likelihood (HR = 2.947, p = 0.018). Patient-level validation showed that a US$10 increase in predicted spending was associated with a 4.2-percentage-point increase in skilled birth attendance (95% CI 2.8–5.6).InterpretationDebt service disproportionately crowds out women's health expenditure, highlighting gendered consequences of fiscal adjustment. Abrupt donor withdrawal makes UHC financing gaps virtually unattainable in aid-dependent LICs without domestic reprioritization. Debt-for-health swaps, phased donor transitions, and increased women's health expenditure shares are critical. Raising the women's health share by ≥2.5 percentage points could increase LIC gap-closure probability to approximately 31% by 2030 (range 22%–41%).
DOI: 10.3389/fgwh.2026.18941052026-10-16 · Editorial
Karin Windsperger, Johanna Alexopoulos, Nadja Taumberger, Christian Göbl
DOI: 10.3389/fgwh.2026.19753832026-10-16 · Review
Lina Mohammad
The purpose of this scoping review was to explore the evidence regarding mental health outcomes, wellbeing status, help-seeking patterns, and culturally congruent care for Muslim American, Arab American, and Arab Muslim American women within the U.S. healthcare system. The review was guided by the Arksey and O'Malley framework and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The search was guided by the Population, Concept, and Context (PCC) framework. Articles were sought from PubMed Central, CINAHL, and Scopus, targeting peer-reviewed articles published between 2016 and 2026. Data were analyzed through narrative synthesis. The review included 29 studies, and five overarching themes emerged: (1) high mental health burden across multiple domains; (2) multi-level barriers to help-seeking and care access; (3) discrimination, Islamophobia, and provider bias as structural stressors; (4) mental health vulnerabilities and unmet care needs during the perinatal period; and (5) resilience, faith, and culturally congruent care as protective factors. Mosque-based, culturally congruent, faith-integrated interventions have demonstrated good acceptability, although evidence of their effectiveness remains preliminary. These findings highlight the need for greater investment in cultural humility training for providers, disaggregated national data on mental health, and intersectional longitudinal studies to improve equitable mental health care for these populations.
DOI: 10.3389/fgwh.2026.19315672026-10-16 · Original Research
Sophia Sgraja, Judith Mollenhauer, Martina Kloepfer, Ute Seeland, Clarissa Kurscheid, Volker E. Amelung
BackgroundGender-sensitive personalized care (GSC+) is a core component of people-centered healthcare and health equity. Evidence from cardiovascular research demonstrates relevant sex- and gender-related differences in symptom presentation, diagnostics, treatment response, and outcomes. These differences are increasingly acknowledged in clinical practice guidelines and nursing expert standards. However, despite growing integration into guideline recommendations, translation into routine clinical practice remains inconsistent. Empirical data integrating both patient and healthcare professional perspectives on guideline-based gender-sensitive care are still limited.MethodsThis exploratory mixed-methods study synthesizes findings from the German health services research project HeartGap (funding number: 01VSF22030; DRKS00031317). The study comprised (1) a scoping review on measures, facilitators, and barriers to implementing GSC+, (2) qualitative expert interviews and focus groups with physicians and nurses, and (3) nationwide surveys with physicians (n = 155), nurses (n = 111), and cardiology inpatients (n = 390). Gender sensitivity among healthcare professionals was assessed using the Nijmegen Gender Awareness in Medicine Scale (N-GAMS), alongside measures of perceived implementation of GSC+. Patient perspectives were analyzed descriptively and using multivariate regression models.ResultsHealthcare professionals demonstrated moderate to high gender sensitivity (physicians: M = 3.95, SD = 0.73; nurses: M = 3.46, SD = 0.76). Perceived implementation of GSC+ was substantially lower, particularly among physicians (M = 2.45, SD = 0.59), compared with nurses (M = 2.91, SD = 0.81) and patients (M = 3.04, SD = 0.65). Higher gender sensitivity did not correspond with higher perceived implementation, indicating a disconnect between attitudes and practice. Although guideline-based knowledge on sex- and gender-related aspects was moderate to high, its translation into routine clinical practice remained limited. Patients evaluated GSC+ positively and reported comparatively low additional needs. Across methods, structural constraints, insufficient operationalization of guideline recommendations, and limited institutional embedding emerged as key barriers.ConclusionOrganizational, structural, and systemic barriers were consistently identified across study components as relevant factors associated with implementation gaps in GSC+ rather than by negative attitudes or lack of awareness among healthcare professionals. Strengthening the evidence base, operationalizing gender-sensitive recommendations, and embedding GSC+ into organizational routines and education are essential to advance people-centered, equitable, and safe cardiology care.
DOI: 10.3389/fgwh.2026.18715462026-10-16 · Original Research
Pernilla Ny, Atika Khalaf, Tinde Dowler, Louise Karlsson, Li Thies-Lagergren
BackgroundFormula supplementation of breastfed infants for non-medical indications is discouraged in Swedish postnatal care. Still, supplementation rates remain high, with 20%-40% of infants receiving formula in postnatal wards. Early formula supplementation has been associated with reduced breastfeeding exclusivity and duration. Little attention has been given to the perspectives of healthcare professionals involved in supplementation decisions, and there is limited understanding of how midwives experience and navigate situations where formula is requested or considered for non-medical reasons.AimTo explore midwives’ experiences of formula supplementation for non-medical indications in postnatal wards.MethodsThis qualitative study used an inductive design with semi-structured interviews. Eleven midwives from three postnatal wards in Southern Sweden participated in individual interviews. The interviews were audio-recorded, transcribed verbatim analyzed using content analysis.ResultsThree categories were identified: Workplace culture is crucial, Negotiating infant feeding decisions and Moral and professional tensions. Midwives described how workplace culture, guideline adherence, knowledge levels, and interprofessional dialogue influenced supplementation practices. Decisions about supplementation were often negotiated in interactions with parents, where midwives sought to facilitate informed decision-making while supporting breastfeeding. Supplementation for non-medical indications was frequently experienced as professionally challenging and emotionally difficult.ConclusionMidwives’ experiences suggest that formula supplementation practices are shaped by organizational culture, professional alignment within the healthcare team, and interactions with parents. Strengthening breastfeeding-promoting postnatal care may therefore require organizational support, consistent education in breastfeeding support, and structures that enable midwives, who possess the strongest expertise, to actively participate in infant feeding decisions together with the mother.
DOI: 10.3389/fgwh.2026.18934842026-10-13 · Study Protocol
Anne Cathrine Staff, Meryam Sugulle, Josef Noll, Miriam K. C. Sollie-Hoel, Belen Oteiza Aguirre, Bendik S. Fiskå, Gunvor Aasbø, Atle Klovning, Mette-Elise Estensen, Åsa Henning Waldum
ObjectiveA history of hypertensive disorders of pregnancy and/or gestational diabetes is associated with increased risk of long-term maternal cardiovascular (CV) disease. Despite recommendations for preventive strategies, few women receive CV follow-up postpartum. We have developed a personalized digital mobile Health companion, the MumCare (Mum’s cardiovascular health for life) application, aiming at improving control of modifiable risk factors for CV disease and to bridge hospital and community health services. This paper describes the protocol for a MumCare randomized controlled trial in Norway.MethodsStudy participation is offered to women at Oslo University Hospital with a diagnosis of hypertensive disorders of pregnancy and/or gestational diabetes. Following informed consent (either during pregnancy or within 4 weeks postpartum), a block randomization process assigns participants to one of two groups (access to the Mum Care app or not). The app provides educational material, allows women to track modifiable risk factors, and prompts feedback to registered blood pressures. It also prompts the women to book the nationally recommended follow-up at their general practitioner’s at 3–4 and 12 months postpartum. The primary study objective is to assess the effect of MumCare application access on 1-year follow-up rate with a general practitioner. Secondary objectives are to assess group differences at 14 months postpartum regarding: 1) satisfaction with the postpartum mHealth-assisted technology, 2) self-management evaluation, general self-efficacy; and at 14–18 months: 3) modifiable risk factors for CV disease (including hypertension, dyslipidemia, blood sugar control, smoking, weight and physical activity), CV non-invasive hemodynamics and CV-related biomarkers.DiscussionThis randomized controlled trial tests the effect of a mobile Health-assisted follow-up of modifiable risk factors after pregnancy complications associated with premature CV disease in women. A study limitation is a risk of underrepresentation of recently immigrated women due to the restricted language options offered in the app.Study protocols registrationNCT05835596.
DOI: 10.3389/fgwh.2026.18899532026-10-13 · Original Research
Shan Chen, Yao Rao, Yaohua Chen, Qian Yang, Guirong Wu, Fang Hu, Youshu Gao, Hongjiang Pu, Jiangping Fu
BackgroundIn recent decades, cancers of the trachea, bronchus and lung cancer (TBL) have been the cancers with the highest global morbidity and mortality rates, with large regional variations, and the highest economic burden of all cancer types, and have shown a clear trend towards feminisation and younger onset. Therefore, we aimed to provide comprehensive insights into the prevalence and impact of TBL in women of reproductive age, taking into account factors such as age and socio-demographic indices (SDI).MethodsTo assess trends in the prevalence of TBL among women of reproductive age, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to systematically assess the burden of CBD and its changes globally, regionally, and nationally from 1990 to 2021. We calculated estimated annual percentage change (EAPC), age-standardised incidence rates (ASIR), age-standardised death rates (ASDR) and disability-adjusted life years (DALYs) for 204 countries and regions from 1990 to 2021. DALYs were used as a measure in conjunction with socio-demographic indices (SDIs). Analyses include the Inequality Slope Index (ISI) and the Concentration Index (CI) to measure health inequalities, frontier analyses to estimate achievable outcomes based on levels of development, decomposition analyses to identify drivers of change in the burden of disease, analysis of yearly cyclical cohort models, and Bayesian age-period-cohort (BAPC) modelling to predict future trends in the burden of disease.ResultsCompared with 1990, there was an increase in global morbidity and mortality from TBL in women of childbearing age in 2021, but there was a decrease in global morbidity and mortality, with the most pronounced downward trend in TBL in women of childbearing age in the 45–49 age group. In contrast, the global rate of DALYs increased, and the highest rate of DALYs in women of reproductive age was found in the 45–49 age group. Only low-SDI regions and medium-low-SDI regions had increased incidence and mortality rates of the 21 GBD regions, East Asia had the highest incidence and mortality rates of the 204 countries, Nigeria had the lowest incidence and mortality rates, Greenland had the highest incidence rates, and Monaco had the highest mortality rates in 2021. From 1990 to 2021, absolute and relative inequality associated with the socio-demographic index (SDI) decreases, but inequality persists. Projections of ASR for women of childbearing age from 2021 to 2035 found an overall declining trend in TBL ASIR and ASMR for women of childbearing age from 2021 onwards.ConclusionAlthough the global age-standardised DALY rates for ASIR, ASDR and TBL in women of reproductive age have decreased over the past three decades, the global burden of TBL is unevenly distributed. Moreover, the prevention and control of TBL in women of reproductive age require international cooperation, multisectoral collaboration, government support, and the joint efforts of women themselves and their families and societies.
DOI: 10.3389/fgwh.2026.16952602026-10-13 · Perspective
Ilyas Abdullahi Khalif, Yusuf Abdullahi Hubow, Ahmed Mohamed Omar, Nour Ahmed Dahir, Aniso Mohamed Abdi
Maternal mental health remains an overlooked dimension of global women's health, particularly in conflict-affected and low-resource settings where psychological distress is intensified by poverty, displacement, violence, gender inequality, and fragile health systems. Although maternal health agendas have achieved progress in reducing mortality, survival-focused approaches often fail to capture the psychological burdens that shape women's well-being, caregiving capacity, and intergenerational outcomes. This Perspective argues that maternal mental health should be reframed as a core component of maternal health rather than a secondary concern. Drawing on a life-course and gender-responsive perspective, we propose a conceptual framework linking conflict and structural inequality with social determinants, maternal psychological outcomes, and consequences for mothers and children. We highlight the need for integrated health-system responses that combine mental health screening, psychosocial support, community-based care, and gender-responsive policies to achieve equitable and sustainable improvements in women's health.
DOI: 10.3389/fgwh.2026.19890392026-10-13 · Original Research
Charles Basil Kafaiya, Stella P. Kilima, Mary T. Mayige, Kijakazi O. Mashoto
BackgroundUnintended and closely spaced births remain important public health concerns. Postpartum family planning provides an opportunity to prevent unintended pregnancies and improve maternal and child health outcomes. However, evidence on the implementation bottlenecks affecting PPFP scale-up in Tanzania remains limited.AimThis study assessed implementation bottlenecks affecting the uptake, scale-up and sustainability of PPFP services in Tanzania and identified and prioritized potential actions to address them.MethodsA cross-sectional study employing a participatory mixed-methods approach was conducted using an adapted WHO PPFP bottleneck assessment tool, stakeholder survey, in-depth interviews, routine health information and population-based survey data, and review of national policies and guidelines. The online stakeholder survey included 477 invited participants, of whom 424 responded (88.9%). In-depth interviews were conducted with 34 stakeholders from regions representing high and low PPFP uptake. Findings from the different data sources were triangulated and presented during a stakeholder consensus meeting, where bottlenecks were ranked and prioritized and corresponding actions were identified.ResultsRoutine and survey data indicated substantial variation in PPFP uptake and an increase in postpartum FP counselling over time, but counselling did not consistently translate into PPFP uptake. The assessment identified gaps in provider capacity, motivation, financing, access to and awareness of updated policies and guidelines, referral systems, equitable access, and the scale-up of innovations. Policy reviews further identified gaps between national guidance and implementation, including limitations in dissemination, monitoring, and alignment with WHO recommendations. The consensus process prioritized actions addressing provider motivation, financing, dissemination of updated guidance and job aids, referral systems, equitable access, innovation scale-up, and provider capacity.ConclusionTanzania has a supportive policy environment for PPFP, but implementation remains constrained by interconnected health-system, provider, and service-delivery barriers. Addressing these bottlenecks through coordinated investments in financing, provider capacity and motivation, guideline dissemination, referral systems, equitable access, and scale-up of effective innovations is essential to strengthen PPFP implementation and uptake.
DOI: 10.3389/fgwh.2026.18750762026-10-13 · Original Research
Susanne Mitschke
ObjectiveMany women use dietary supplements to manage menopause symptoms, yet patterns of use, perceived effectiveness, and information sources remain incompletely described in contemporary literature. This cross-sectional study assessed current dietary supplement use, including use specifically for menopause symptoms, and perceptions of menopausal hormone therapy (MHT) among symptomatic menopausal women aged 45–65 years.MethodsAn online questionnaire was administered to a self-selected sample of 226 perimenopausal or postmenopausal participants recruited through online health forums, social media, menopause support groups, and newsletters. Survey items captured sociodemographic characteristics, health, supplement use, perceived effectiveness, information sources, and MHT awareness and concerns. Associations were examined using cross-tabulations, chi-square and exact tests, Spearman correlations, and logistic regression.ResultsCurrent use of at least one dietary supplement, for any purpose, was reported by 138 participants (61.1%; 95% CI 54.6–67.2). Self-reported use of supplements specifically to manage menopause symptoms (menopause-targeted use) was reported by 65 participants (28.9%; 95% CI 23.4–35.1). Among supplement users, the most frequently reported products were multivitamins (55.8%), vitamin D (52.9%), magnesium (51.4%), and probiotics (41.3%). MHT awareness was high (n = 187, 82.7%) and increased with income. Concerns about breast cancer (47.8%), blood clotting (44.7%), stroke (40.7%), and heart disease (37.2%) as risks of MHT were frequently reported. Healthcare providers and online sources were the leading sources of information, and social media influencers were rated least trustworthy. Former smokers (adjusted OR 2.98, 95% CI 1.21–7.34) and never smokers (adjusted OR 3.92, 95% CI 1.59–9.65) had higher odds of any supplement use than current smokers; this association was not observed for menopause-targeted use.ConclusionIn this self-selected online sample, current dietary supplement use for any purpose was common, although fewer than half of supplement users reported using supplements to manage menopause symptoms. Concerns about MHT persisted despite high awareness. These estimates should not be generalized to the broader population of midlife women. Future studies using probability-based samples and validated symptom measures are needed to characterize menopause-targeted supplement use and to inform clinical strategies that support individualized menopause care.
DOI: 10.3389/fgwh.2026.19244612026-10-12 · Original Research
Adelaide Lusambili, Fiona Scorgie, Matthew Chersich, Britt Nakstad, Stanley Luchters, Peter Khaemba, Veronique Filippi, Jeremy Hess, Sari Kovats
BackgroundIn coastal Kenya, high seasonal temperatures compound structural challenges that include intermittent water access, resulting in health burdens from extreme heat. Women can experience limitations in the coping strategies available to them for protecting their health and wellbeing from high indoor and outdoor temperatures. This paper, drawing on the Climate Heat and Maternal Neonatal Health Africa (CHAMNHA) study, aims to describe how mothers and their newborns in rural Kilifi cope with extreme heat in their daily routines.MethodsThis qualitative study draws on key informant interviews, in-depth interviews, and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (n = 22), as well as frontline health providers, policy influencers, and government stakeholders (n = 16). Participants were recruited in Rabai and Kaloleni Counties in Kilifi, on Kenya's coast, during a season characterised by extreme heat and drought. Data were analysed using NVivo 12, applying a combination of inductive and deductive thematic approaches.ResultsWomen described five main strategies for coping with extreme heat. These included reducing or removing clothing, seeking outdoor shade and fresh air, ventilating indoor spaces, bathing and drinking cold water, and reducing or rescheduling daily activities. These strategies were also adapted for infant care. Mothers reduced infants’ clothing, moved them into shaded outdoor spaces, bathed or sponged them more frequently, and used culturally familiar remedies to manage heat-related discomfort and rashes. These practices provided immediate but partial relief. Heat-retaining and poorly ventilated housing, unreliable electricity, water scarcity and contamination, and diminishing tree cover limited women's options. Some strategies also introduced additional risks. Sleeping outdoors increased exposure to mosquitoes and personal-safety concerns, while opening windows brought dust into homes. Expectations concerning modesty, women's domestic workloads, and appropriate newborn care further constrained coping and sometimes created tension with older household members. Coping therefore involved continuous trade-offs between short-term thermal relief and social, environmental, and health risks.ConclusionPregnant and postpartum women in rural Kilifi manage extreme heat through individual and household practices shaped by cultural expectations and material constraints. These practices offer only temporary relief, increase caregiving demands and, in some cases, shift rather than reduce risk. Responsibility for adaptation therefore falls largely on women themselves. Protecting maternal and newborn health is likely to require heat–health guidance in routine antenatal and postnatal care, engagement of households and community actors, and investment in reliable water, cooler housing and shade.
DOI: 10.3389/fgwh.2026.18253482026-10-09 · Original Research
Lara Nixon, Elaine Boyling, Emma Mierau, Rebecca Hughes, Jeuel Ugburo-Shanomi, Martina Kelly
BackgroundWhile women's homelessness is increasingly recognized as a gendered issue, experiences of aging while homeless remain underexplored. This study examined how older women navigate intersections of aging, health, and homelessness, focusing on how these experiences are shaped by structural and social factors.MethodsWomen's lived experiences were explored and interpreted using a narrative approach. Eleven women (aged 57–65 years) took part in two in-depth interviews each, followed by participation in three sequential focus groups. Data were analyzed iteratively informed by Riessman's thematic and structural narrative analysis. Focus groups served as collaborative spaces to provide feedback on initial interpretations and deepen understanding of experiences across social and structural contexts. Co-constructed storylines and composite narratives are presented of participants' re-structured experiences.FindingsTwo main storylines were identified and supported the development of an overarching counter narrative. The first, ‘Hurry up and Wait', describes the tension women felt within bureaucratic systems that appeared to offer assistance but were experienced as burdensome and disempowering. Shelters and temporary housing were depicted as unsafe and detrimental to health, including hampering their ability to maintain family relationships. The second storyline, ‘Making lemonade', reflects women's agency in managing their health and supporting each other. Despite systemic marginalization, women kept meaningful connections with friends, family, and community, which were a vital form of social capital.ConclusionIn dominant discourses on homelessness, women's experiences are often hidden and seen through stigmatizing views. This study shows how older women competently navigate complex systems and resist this characterization, creating networks and using caregiving roles to provide mutual support. We propose this labor as a previously unrecognized form of social capital through which women who are homeless affirm their worth and support one another.
DOI: 10.3389/fgwh.2026.17408142026-10-09 · Original Research
Final Zimkhitha Juqu, Zamadonda Xulu-Kasaba, Olivia B. Baloyi
IntroductionMaternal mortality remains a significant public health concern in South Africa, particularly in resource limited settings where timely access to higher-level care is vital. Community Health Centres are the first point of contact for women faced with obstetric emergencies, yet systemic, contextual, and operational challenges impede effective upward referral. Guided by Straussian Grounded Theory, this qualitative study explored the contextual conditions shaping the upward referral of obstetric emergencies in the OR Tambo district, Eastern Cape.MethodsData was collected through focus group discussions, in–depth interviews, document analysis, and observations, and analysed using open, axial, and selective coding.ResultsFindings revealed four key categories which were resource limitations, workforce and budget gaps, communication and Emergency Medical Services, geographical and socioeconomic barriers.DiscussionThese interrelated conditions contribute to delayed, unsafe, and fragmented referrals, placing mothers and newborns at heightened risk of further complicated conditions. Addressing these systemic challenges requires multi-sectoral interventions, including regular multidisciplinary emergency obstetric training, strengthened referral communication, investment in transport infrastructure and facility-based ambulances.ConclusionThis study indicates that strengthening referral process is essential in enhancing timely and safe obstetric care, ultimately reducing preventable maternal and neonatal mortality.
DOI: 10.3389/fgwh.2026.19246672026-10-09 · Editorial
Elena Marbán-Castro, Xiaohui Sem, Elena Dacal, Maria Cristina Manzanares-Céspedes
DOI: 10.3389/fgwh.2026.19693202026-10-09 · Original Research
Sharron Hinchliff, Kristina Potočnik, Gayathri Delanerolle, Julie Taylor, Kathryn Elliot, Donatella Fontana, Lucky Saraswat, Nick Panay, Vikram Talaulikar, Carol Atkinson, Helen Felicity Kemp, Om Kurmi, Nirmala Rathnayake, Lamya Al-Kharusi, Vindya Pathiraja, Nihal Al-Riyami, Ramya Palanisamy, George Uchenna Eleje, Peter Phiri
BackgroundCognitive changes are widely experienced during the menopause transition and, when severe, can disrupt women's working lives and negatively impact their mental health. While prior research has documented the detrimental effect of menopausal symptoms on women's quality of life, there remains a paucity of empirical evidence specifically exploring the intersection between cognitive changes and identity reconstruction within occupational settings. The objective of this study was to understand women's experiences of cognitive changes at work during menopause, including how they navigate these difficulties.MethodsThis qualitative, exploratory study, involved in-depth interviews with 50 women aged 43–67 years (mean 52.3) recruited for the MARIE-UK (WP2a) project. Data were analysed using collaborative reflexive thematic analysis, through the lens of Conservation of Resources (COR) theory. Data trustworthiness was ensured through investigator consensus.ResultsThe majority of participants experienced cognitive changes at menopause, such as brain fog and memory problems, which negatively impacted their mental health at work. Participants experienced loss of confidence in their abilities, an increase in anxiety, and a change in their sense of self. Due to the depletion of valuable resources (resources are anything an individual values), they struggled to regain a semblance of normality. Those who received workplace support managed to break the spiral of resource loss and better cope with the detrimental effects of the symptoms.ConclusionUnderstanding women's experiences of cognitive changes and mental health in the workplace through the COR theory has shown that menopause is a demand that can significantly deplete women's valuable resources to perform their work duties. Menopausal cognitive changes profoundly disrupted their sense of self and perceived ability to work effectively. The intersection of cognitive and psychological symptoms with workplace stressors exacerbated mental health burdens and perpetuated gender inequalities. Interventions to support workplace wellbeing are required, particularly as the proportion of menopausal women in paid employment increases.
DOI: 10.3389/fgwh.2026.18784232026-10-09 · Original Research
Julianne Lundanes, John Roger Andersen, Jutta Dierkes, Klaus Schrader, Siren Nymo
BackgroundThere are no validated Norwegian disease-specific patient-reported outcome measures (PROMs) assessing quality of life (QoL) in females with lipedema, limiting evaluation of treatment effect in clinical practice and research.ObjectiveTo translate and validate a Norwegian translation of the LIPQOL questionnaire.MethodsA cross-sectional validation study was performed in 432 females with lipedema in Norway. Descriptive statistics and floor and ceiling effects were assessed. The psychometric properties of the questionnaire were assessed using confirmatory factor analysis (CFA). The overall goodness of fit was evaluated using the root mean square error of approximation (RMSEA), the comparative fit index (CFI) and the Tucker–Lewis index (TLI). Internal consistency was assessed using composite reliability from the CFA. Associations between LIPQOL subscales and RAND-12 physical component score (PCS) and mental component score (MCS) were examined using Spearman correlations.ResultsThe LIPQOL questionnaire comprises four subscales, Function, Body image, Symptoms, and Feelings. No subscales was affected by floor or ceiling effects. The unmodified CFA shows CFI = 0.929, TLI = 0.922, standardized root mean square residual (SRMR) = 0.073, and RMSEA = 0.079 (90% CI: 0.073 to 0.084). All composite reliability were considered reasonable (ranged from 0.890 to 0.916). Modification indices were evaluated, and two modifications were performed between items 5 and 8, and between items 17 and 18. With modification indices, the overall structure validity showed reasonable, but not unequivocally support for the four factor structure with CFI = 0.944, and TLI = 0.938, SRMR = 0.068, and RMSEA = 0.070 (90% CI: 0.064 to 0.075). Correlation between RAND-12 and LIPQOL subscales were large. Function, Symptoms, and overall quality of life show large correlation with PCS (Spearman's rho = −0.682, Spearman's rho = −0.550, and Spearman's rho = 0.554, respectively) and the subscales feelings and overall quality of life shows large correlation with MCS from RAND-12 (Spearman's rho = −0.685 and 0.608, respectively).ConclusionInitial findings suggest that the Norwegian version of the LIPQOL is a reasonably valid instrument for assessing quality of life in females with lipedema, although the findings do not provide unequivocal support for all aspects of its measurement properties.
DOI: 10.3389/fgwh.2026.19172742026-10-08 · Original Research
Ayagyoz Umbetzhanova, Adina Kusniyeva, Gulmira Derbissalina, Aigul Abduldayeva, Nikolay Safonov, Vitaliy Koikov
BackgroundKazakhstan reintroduced human papillomavirus (HPV) vaccination in 2024, making public confidence and communication important. This study described HPV knowledge and trust in information sources and exploratorily examined vaccine-perception structure and correlates among women attending primary care in Astana.MethodsA cross-sectional electronic survey was conducted from 17 January to 28 February 2026 among 221 adult women recruited through convenience sampling. HPV knowledge, source-specific trust, and 16 perception items were assessed. Exploratory psychometric analysis used polychoric correlations, parallel analysis, and principal-axis factor analysis with oblimin rotation to derive preliminary composite measures. Spearman correlations and robust multivariable linear models examined safety concern and perceived effectiveness. A secondary logistic model examined refusal or intention to refuse HPV vaccination for a daughter.ResultsMean HPV knowledge was 4.95 ± 3.84 of 12. A five-item safety concern measure (mean 2.34 ± 0.97; α = 0.868; ω = 0.901) and a three-item perceived effectiveness measure (mean 3.20 ± 1.24; α = 0.922; ω = 0.948) were derived. Knowledge correlated negatively with safety concern (ρ = −0.284, p < 0.001) and positively with perceived effectiveness (ρ = 0.393, p < 0.001). Safety concern was associated with COVID-19 controversy spillover (B = 0.190, 95% CI 0.043−0.337), earlier-programme distrust (B = 0.197, 95% CI 0.047−0.347), and preference for natural immunity (B = 0.137, 95% CI 0.040−0.234). Higher knowledge (B = 0.061, 95% CI 0.010−0.111) and professional/scientific trust (B = 0.297, 95% CI 0.114−0.480) were associated with greater perceived effectiveness. Forty-nine participants (22.2%) reported refusal or intention to refuse vaccination for a daughter; knowing someone believed to have become seriously ill after vaccination was associated with this response (aOR 7.42, 95% CI 2.60−21.16).ConclusionHPV vaccine perceptions were multidimensional. Knowledge and professional-scientific trust were linked mainly to perceived effectiveness, whereas safety concerns were more strongly related to vaccine narratives. Communication strategies should combine factual education with transparent safety dialogue and clinician communication.
DOI: 10.3389/fgwh.2026.19602522026-10-07 · Systematic Review
Mandu Stephen Ekpenyong, Khatidja Chantler, Gillian Janes
PurposeDomestic abuse (DA) is a significant public health and human rights issue with profound physical, psychological, and social consequences. Healthcare settings provide important opportunities for identification and support; however, disclosure by women remains inconsistent, and healthcare professionals’ readiness to identify and respond varies widely. This qualitative systematic review synthesised evidence examining factors influencing women's disclosure of DA within healthcare contexts and healthcare professionals’ preparedness to respond.MethodsA systematic search of MEDLINE, Embase, CINAHL, PsycINFO, and Scopus was conducted for studies published between 2000 and 2023. Additional studies were identified through reference searching. The review followed PRISMA guidance and was informed by the SPIDER framework. Qualitative and mixed-methods studies with extractable qualitative findings were included. Methodological quality was appraised using the Critical Appraisal Skills Programme checklist. Findings were synthesised narratively and interpreted using a socio-ecological model to capture multilevel influences on disclosure and response.ResultsDisclosure emerged as a relational and socially mediated process shaped by trust, perceived safety, validation, confidentiality, and continuity of care. Forms of “borrowed trust,” mediated through social networks, influenced women's willingness to engage. Healthcare professionals’ preparedness was determined by competence, confidence, emotional readiness, clarity of safeguarding responsibilities, and access to referral pathways. Structural factors, including limited consultation time, workload pressures, and organisational ambiguity, constrained effective response. Importantly, disclosure alone did not ensure improved outcomes where system readiness was inadequate.ConclusionImproving responses to DA requires multilevel strategies extending beyond individual training. Sustainable progress depends on organisational leadership, protected time, clear referral systems, and alignment across relational and structural domains to support safe disclosure and meaningful intervention.
DOI: 10.3389/fgwh.2026.17023072026-03-27
Miwako Okamoto, Sunila Shakya, Subasna Shrestha, Eiko Kaneda, Seira Kawada, Kenji Ohishi
BackgroundPostpartum emotional distress, including depression, anxiety, and stress, is a public health concern affecting maternal well-being and child development. Although several studies have identified risk factors among Nepalese women, little is known about the multifactorial pathways underlying postpartum emotional distress. This study aimed to determine the prevalence of postpartum emotional distress and to examine the pathways and interrelationships among factors associated with postpartum emotional distress among women in the Kathmandu Valley, Nepal.MethodsA hospital-based cross-sectional study was conducted at a tertiary hospital in central Nepal. A total of 381 postpartum women (4–12 weeks after delivery) were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the General Health Questionnaire-12 (GHQ-12). Sociodemographic, perinatal, childcare-related, and psychosocial data were collected. Exploratory factor analysis and structural equation modeling (SEM) were used to identify latent factors and the relationships among them.ResultsThe prevalence of postpartum emotional distress was 40.2% (95% CI: 35.2–45.3). Factor analysis identified seven latent factors: Childcare Experience, Mother's Economic Strength, Age of Parents, Extended Family Support, Emotional Distress, Help from Husband, and Satisfaction with Married Life. SEM demonstrated good fit (CFI = 0.971, RMSEA = 0.043). Satisfaction with Married Life (standardized coefficient: −0.66, p < 0.01), Help from Husband (−0.15, p < 0.01), Extended Family Support (−0.15, p < 0.05), and Mother's Economic Strength (−0.16, p < 0.05) were inversely associated with emotional distress.ConclusionsPostpartum emotional distress is highly prevalent among Nepalese women. Strengthening family and partner support, promoting community-based interventions, and enhancing routine mental health screening by health professionals are essential to both reduce distress and improve the psychological well-being of mothers and long-term outcomes for children.
DOI: 10.3389/fgwh.2026.17235562026-03-25
Anne Achieng, Sarah C. Blake, Ramatou Ouedraogo, Caroline Kabiru, Marni Sommer
IntroductionType III female genital mutilation/cutting (FGM/C), or infibulation, negatively impacts girls' and women's health and well-being. Some evidence suggests women who have experienced infibulation may have distinct menstrual health challenges. However, the intersection of infibulation and menstrual health is under-explored. The present study documented women's and providers' perspectives on menstrual health and infibulation among Somali communities in Wajir County, Kenya.MethodsWe conducted a qualitative study including in-depth interviews (n = 23) with Somali women ages 18–45, and key informant interviews (n = 10) with healthcare providers. Interviews with women explored their reflections on and experiences of FGM/C, including infibulation, menstrual health, and perceived connections between the two. Interviews with healthcare providers explored their perspectives on women's healthcare needs in relation to menstrual health and infibulation.ResultsThematic analysis identified three themes: (1) informal discussion among women shapes their menstruation and infibulation knowledge; (2) multiple factors that shape women's care-seeking for menstrual health concerns; and (3) healthcare providers lack the necessary preparation to address menstrual health concerns among women who have undergone infibulation.DiscussionThis study's findings provide insights into the intersections of menstrual health and infibulation within the broader educational, social and healthcare context of Somali communities in rural Kenya. While women learn, interpret, and describe infibulation as a source of acute menstrual health problems, including menstrual pain and irregular bleeding, clinical evidence on this relationship is needed. Findings illuminated multiple factors inhibiting Somali women's receipt of adequate care for menstrual health needs. Additional challenges included women's perceptions of healthcare quality, distrust of formal healthcare providers, and gendered family decision-making processes around healthcare. Healthcare providers' inadequate training and support hindered diagnosis and care for menstrual disorders for women who have and have not experienced infibulation, while confusion about Kenya's FGM/C ban further complicates provider engagement.
DOI: 10.3389/fgwh.2026.17534592026-03-23
Panpan Duan, Chengcheng Zhang, Qianqian Yang
ObjectiveTo investigate the correlation between vaginal microbiota indicators and HPV infection, providing a reference for clinical prevention and treatment of HPV-related diseases.MethodsClinical data of 5,362 female patients who underwent vaginal microbiota testing and HPV detection were retrospectively analyzed. The distribution of vaginal microbiota indicators and their association with HPV infection were statistically analyzed using the chi-square test. Three hundred fifty-five patients infected with HPV 16/18 were enrolled, followed up their HPV re-detection results at 12 months, and performed univariate analysis and logistic regression analysis to identify the risk factors for persistent HPV infection.ResultsAmong the 5,362 subjects, the positive rates of hydrogen peroxide, sialidase, leukocyte esterase, Trichomonas vaginalis, mold, and clue cells were 96.38%, 16.51%, 59.29%, 0.93%, 16.09%, and 8.65% respectively. 63.19% of the subjects had vaginal cleanliness of III-IV, and 71.73% had a vaginal pH value >4.5. Statistical analysis showed that sialidase (χ2 = 4.13, P = 0.04), and vaginal cleanliness (χ2 = 8.32, P = 0.00) were significantly associated with HPV infection; Vaginal Cleanliness(χ2 = 8.32, P = 0.04) and pH(χ2 = 14.63, P = 0.00) were significantly associated with HPV Genotypes. Vaginal pH value (OR = 2.65, 95% CI: 1.55–4.52, P < 0.001), N-acetylglucosaminidase positive (OR = 2.14, 95% CI: 1.12–4.08, P = 0.021), and fungus detected (OR = 1.88, 95% CI: 1.06–3.35, P = 0.032) were identified as independent risk factors for persistent HPV infection.ConclusionVaginal microbiota imbalance, as indicated by abnormal sialidase, poor vaginal cleanliness, and elevated pH value, may be related to HPV infection. Vaginal pH value, N-acetylglucosaminidase positive and fungus detected were identified as independent risk factors for persistent HPV infection.
DOI: 10.3389/fgwh.2026.18094492026-03-23
Miranda Atembeshu, Dirk Lafaut
IntroductionThis article examines the maternity care experiences of Black Sub-Saharan African migrant women living in Belgium during the COVID-19 pandemic, using the lens of Critical Race Theory (CRT). It explores how women describe their interactions with maternal healthcare providers and how intersecting factors-race, migration status, language, and gender - shaped their maternity care.MethodsThe study employed a qualitative, narrative design combining semi-structured, in-depth interviews with 30 women who gave birth in Belgium between 2020 and 2022, alongside participant observation at a Born House. The data were analyzed through a multi-phase thematic analysis that, in line with CRT, focused on counter-stories.ResultsFindings show that the pandemic and the measures to contain it compounded and exacerbated experiences of stereotyping, linguistic racism, and obstetric violence among Black migrant women. Stereotyping contributed to inadequate pain management, delayed diagnoses, and a lack of emotional support. COVID-19 measures - such as mask mandates, teleconsultations, and reduced availability of interpreters - intensified existing language barriers in interaction with maternal healthcare providers, enabling the expression of racist attitudes and reinforcing systemic exclusion from pregnancy-related decision-making. As a result, many women reported feeling wronged or coerced during and after childbirth. Mechanisms of redress did not accompany processes of blame attribution.DiscussionFrom a CRT perspective, we argue that pandemic measures without consideration of the specific needs of racialized migrants and linguistic minorities constitute a form of institutional neglect, reinforcing pre-existing inequities in maternity care. Tackling structural racism is not only a long-term imperative, but also requires acute awareness of the needs of racialized minorities when introducing new, ostensibly universal public health measures in times of crisis. View less
DOI: 10.3389/fgwh.2026.16929452026-03-16
Camille Drouillard, Ana García Navarro
Violence against women is an urgent public health and human rights issue. This study evaluated the effectiveness of forensic dentistry in diagnosing, preventing and comprehensively addressing domestic violence, identifying challenges and proposing improvements. A search of PubMed, Scopus and Web of Science was conducted until December 2024 selecting 9 studies including 949 female victims and 1,274 professionals. The most frequent injuries were maxillofacial and dental fractures, and the aggressors were mainly intimate partners. There was evidence of insufficient training of professionals, with moderate knowledge of physical signs and limited knowledge of behavioural indicators. The main barriers were fear of intervention, lack of protocols and the presence of the aggressor during care. Forensic dentistry plays a crucial role, but it is essential to improve professional training and incorporate specific protocols in clinical practice.
DOI: 10.3389/fgwh.2026.1745030