Insights & Updates

In “SRH in Palestine: A Medical Student’s Experience in Health Education,” Duha Shelah, a medical student at An-Najah National University, explains the strengths and weakness in sexual reproductive health care in Palestine. Shelah has worked as a volunteer health educator for the Palestinian medical Relief Society since 2020, working with communities in the Occupied Palestinian Territories. Surprisingly, the majority of Palestinian women receive adequate antenatal care and had a skilled health staff at livebirths. However, a lot of the research on Palestinian reproductive and sexual health is incomplete, especially on menopause, preconception, and psychosocial services. Shelah found that the Israeli involvement in Occupied Palestinian Territories, and the imposition of closures and military checkpoints, restricts access to medical facilities. Therefore, sexual and reproductive health is heavily impacted by times of heightened violence, such as the 2014 bombing of the Gaza strip. Moreover, between 1999 and 2002, home births grew by over 20% due to increased Israeli military presence. Shelah argues that...

Magnetic resonance imaging (MRI) is a sensitive modality for detection of breast cancer; yet, as its use in screening is expanded from high-risk patients to intermediate- and average-risk individuals, positive predictive value deteriorates, leading to unnecessary biopsies and follow-up. To improve the overall accuracy of breast cancer diagnosis and allow for personalization of patient management, Witowski et al., reporting in Science Translational Medicine(1), propose an artificial intelligence-based solution. A system of deep neural networks was trained to output the probability of malignancy given the MRI sequences of a patient’s breast. The deep learning system performed equivalently to board-certified breast radiologists, generalized well to different patient populations in three external test sets, and was unbiased with respect to patient race. Importantly, the model predictions could serve as an aid for downgrading certain breast lesions from BI-RADS 4 to BI-RADS 3, enabling patients with lower risk of malignancy to opt of unnecessary biopsies. The results of the study underscore the value of...

Almost 20% of women aged 15 to 44 years old douche, which is the harmful act of cleaning or washing out the inside of the vagina with a mixture of fluids. Douches are often sold at as prepackaged mixtures containing water with some combination of iodine, vinegar, or baking soda and squirted into the vagina. While it is popularly known to be a sterilizing practice, douching actually changes the balance of vaginal flora (which is the good, natural bacteria inside the vagina) and increases rates of harmful vaginal bacteria. This bacterial increase can lead to yeast infections, bacterial vaginosis (a vaginal infection), or STIs including HIV and pelvic inflammatory disease (an infection in female reproductive organs).   Douching can also cause fertility challenges. It can make it more difficult to get pregnant, as women who did not douche had an easier time getting pregnant than women who douched often (at least once a month). Douching can also increase the risk of ectopic...

A recent study from researchers at Washington State University has shown success in keeping semen in its gel form to block sperm movement and possibly prevent pregnancy. The methods used in this study may eventually materialize into a non-hormonal female contraception method that could be available for over-the-counter purchase. Past research on mice found that the use of a non-specific protease inhibitor called AEBSF prevented the degradation of the protein of Semenogelin 1. Semenogelin 1 (SEMG1) is a protein that traps semen and prevents movement; therefore, its degradation is necessary for sperm liquefaction, where semen is transformed from a gel-like consistency to liquid. By inhibiting the degradation of SEMG1, the researchers were able to prevent the female mice from becoming pregnant. To determine the efficacy of these inhibitors in humans for contraception, the study tested the effects of AEBSF on SEMG1 degradation, which prevented degradation and reduced sperm motility. They next tested the results of a neutralizing antibody that directly inhibited...

The global incidence of sexually transmitted infections (STIs) is high, which has adverse effects on sexual and reproductive health outcomes. Given the widespread use of hormonal contraceptives (HC), it is important to consider their potential etiological association with acquisition of STIs. In a systematic review and meta-analysis recently published in Scientific Reports(1), Akter et al. examined associations between HC use (progesterone-only, combined estrogen-progesterone, or unspecified) and prevalence, incidence, or recurrence of STIs, compared with a control group of non-users of HC. A positive association with HC use was observed for risk of chlamydia trachomatis and herpes simplex virus type 2, in contrast to a negative association for risk of trichomoniasis and bacterial vaginosis. Importantly, only around half of all associations included in the meta-analysis were adjusted for condom use. Furthermore, while a plausible biological explanation based on the interaction between pathogen, host immune response, and vaginal microbiome can be proposed for these findings, the effects of differential sexual behavior, testing,...

In 2021, the United Nations Children's Fund (UNICEF) found that only four out of every ten women use contraception in Nigeria. To help address this sexual and reproductive health disparity (SRH), the World Health Organization (WHO) has coordinated with Nigeria’s Ministry of Health employing a people-centered, and gendered approach to increase the accessibility of SRH services. In particular, WHO has found that self-administration of injectable contraception has already made strides in improving contraceptive uptake regionally. This method has been made available directly within communities through pharmacies and drug stores.   The UN reports that self-administered methods are popular because women can use it in any setting, whether they are in a community setting, refugee camp, or anywhere else. The injection provided by WHO allows up to three months of contraceptive cover, which assists women who desire long-lasting protection. The organization states that this intervention helps give women greater autonomy, and even reduces the pressure on health workers, especially in conflict settings where...

In “Midwives can alleviate the maternal health crisis. Here’s how,” The Hill reporters Lauren K. Hall and Elise Amez-Droz argue that bringing back midwives is an essential maternal health care initiative. Right now, the United States has the worst maternal mortality rate of developed nations and has a host of issues threatening delivery care. Medicaid covers 42% of births a year in the United States, but its poor reimbursement rates incentivize providers to opt out of the program. Because of low provider pay and COVID-19 overwhelming hospitals, 7 million Americans live in areas with limited access to maternity care, putting their health in danger. Hall and Amez-Droz argue that the United States should remove regulations to midwives practicing autonomously by splitting Medicaid reimbursement for birthing care, making it easier for non-medical providers to cooperate, and roll back some licensing laws around midwifery. Black mothers, who face the highest rate of maternal mortality in the United states, are increasingly seeking midwives...