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IntroductionRacial discrimination has been consistently linked to various health outcomes and health disparities, including studies associating racial discrimination with patterns of racial disparities in adverse pregnancy outcomes. To expand our knowledge, this systematic review and meta-analysis assesses all available evidence on the association between self-reported racial discrimination and adverse pregnancy outcomes.MethodsEight electronic databases were searched without language or time restrictions, through January 2022. Data were extracted using a pre-piloted extraction tool. Quality assessment was conducted using the Newcastle–Ottawa Scale (NOS), and across all included studies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects meta-analyses were performed on preterm birth and small for gestational age. Heterogenicity was assessed using Cochran’s χ2 test and I2 statistic.ResultsOf 13 597 retrieved records, 24 articles were included. Studies included cohort, case–control and cross-sectional designs and were predominantly conducted in the USA (n=20). Across all outcomes, significant positive associations (between experiencing racial discrimination and an adverse pregnancy event) and non-significant associations (trending towards positive) were reported, with no studies reporting significant negative associations. The overall pooled odds ratio (OR) for preterm birth was 1.40 (95% CI 1.17 to 1.68; 13 studies) and for small for gestational age it was 1.23 (95% CI 0.76 to 1.99; 3 studies). When excluding low-quality studies, the preterm birth OR attenuated to 1.31 (95% CI 1.08 to 1.59; 10 studies). Similar results were obtained across sensitivity and subgroup analyses, indicating a significant positive association.ConclusionThese results suggest that racial discrimination has adverse impacts on pregnancy outcomes. This is supported by the broader literature on racial discrimination as a risk factor for adverse health outcomes. To further explore this association and underlying mechanisms, including mediating and moderating factors, higher quality evidence from large ethnographically diverse cohorts is needed.

Background and objectivesClimate change has intensified extreme heat events, disproportionately affecting women in low- and middle-income countries (LMICs) through pregnancy complications, higher mortality rates and compounded socioeconomic vulnerabilities. Despite numerous interventions, limited research evaluates health impacts or integrates gender considerations. This study identifies community-level heat adaptation interventions measuring health outcomes in LMICs and examines gender integration using a socioecological framework.MethodsWe conducted a scoping review using the Joanna Briggs Institute guidelines. We searched MEDLINE, EMBASE, Global Health and Scopus. Primary studies, published between 2013 and 2024, that described community-level heat adaptation interventions in LMICs (as defined by the World Bank) and reported at least one human health outcome were included. The review was limited to English-language publications. Gender integration was assessed using the World Health Organization's (WHO) Gender-Responsive Assessment Scale, assigning each study an overall rating across five domains on the gender continuum.ResultsOf 468 studies, 5 met the inclusion criteria, with 1 study each from India, Pakistan, Nicaragua, Burkina Faso and El Salvador. Participant numbers ranged from 16 to 18 000. The interventions described included cool roofing technologies, workplace interventions and community education programmes. Health outcomes measures included physiological indicators (eg, heart rate and sleep) and changes in knowledge, attitudes and practices related to heat stress. Three studies were classified as gender blind, one as gender sensitive and one as gender specific. Studies reported short durations, reliance on self-reported data and sustainability challenges.ConclusionThere is a limited number of studies reporting the effects of heat adaptation interventions on health outcomes in LMICs, and most of these do not sufficiently consider gender differences in either their design or implementation. Our findings emphasise the need for more research in this area with a focus on gender-integrated interventions to effectively mitigate heat-related health risks for vulnerable populations in LMICs.

Access to safe abortion has been recognized as a fundamental human right and important public health priority. Medical schools provide a rare opportunity to expose medical students to comprehensive sexual and reproductive health (SRH) topics and normalize abortion care early in a physician's career. This cross-sectional descriptive study used an online survey to explore abortion content in medical curricula and medical student intentions, attitudes, and beliefs regarding abortion provision among 1,699 medical students from 85 countries. Results demonstrate positive attitudes towards abortion provision, with 83% reporting that \"access to safe abortion is every woman's right\". Students also reported a relatively high willingness to provide abortion professionally despite few opportunities to learn about this care. Only one-third of students surveyed reported having taken a gynecology course (  = 487; 33%); among these, one-third said they had no content on abortion care in their programs thus far (  = 155; 32%), including instruction on postabortion care. Among the two-thirds of students who had some content on abortion care (  = 335), either on induced abortion, postabortion care (PAC), or both, 55% said content was limited to one lecture and only 19% reported having an opportunity to participate in any practical training on abortion provision. Despite most students having no or very limited didactic and practical training on abortion, 42% intended to provide this care after graduation. Three-quarters of student respondents were in favor of mandatory abortion education in medical curricula. The findings of this study offer new evidence about abortion care education in medical curricula around the globe, indicating that there is no lack of demand or interest in increasing medical knowledge on comprehensive abortion care, merely a lack of institutional will to expand course offerings and content.

Inspired by the 2021 BMJ Global Health Editorial by Atkins et al on global health (GH) teaching during the COVID-19 pandemic, a group of GH students and recent graduates from around the world convened to discuss our experiences in GH education during multiple global crises. Through weekly meetings over the course of several months, we reflected on the impact the COVID-19 pandemic and broader systemic inequities and injustices in GH education and practice have had on us over the past 2 years. Despite our geographical and disciplinary diversity, our collective experience suggests that while the pandemic provided an opportunity for changing GH education, that opportunity was not seized by most of our institutions. In light of the mounting health crises that loom over our generation, emerging GH professionals have a unique role in critiquing, deconstructing and reconstructing GH education to better address the needs of our time. By using our experiences learning GH during the pandemic as an entry point, and by using this collective as an incubator for dialogue and re-imagination, we offer our insights outlining successes and barriers we have faced with GH and its education and training. Furthermore, we identify autonomous collectives as a potential viable alternative to encourage pluriversality of knowledge and action systems and to move beyond Western universalism that frames most of traditional academia.

To assess and improve student adherence to hand hygiene indications using radio frequency identification (RFID) enabled hand hygiene stations and performance report cards. Students volunteered to wear RFID-enabled hospital employee nametags to monitor their adherence to hand-hygiene indications. After training in World Health Organization (WHO) hand hygiene methods and indications, student were instructed to treat the classroom as a patient care area. Report cards illustrating individual performance were distributed via e-mail to students at the middle and end of each 5-day observation period. Students were eligible for individual and team prizes consisting of Starbucks gift cards in $5 increments. A hand hygiene station with an RFID reader and dispensing sensor recorded the nametag nearest to the station at the time of use. Mean frequency of use per student was 5.41 (range: 2-10). Distance between the student’s seat and the dispenser was the only variable significantly associated with adherence. Student satisfaction with the system was assessed by a self-administered survey at the end of the study. Most students reported that the system increased their motivation to perform hand hygiene as indicated. The RFID-enabled hand hygiene system and benchmarking reports with performance incentives was feasible, reliable, and affordable. Future studies should record video to monitor adherence to the WHO 8-step technique.

Prior to the pandemic, in-person international conferences and meetings held a fundamental role in intergovernmental and multistakeholder decision-making, advocacy and networking within the global health landscape, but COVID-19 forced borders to close, and for diplomacy and decision-making to thus take place virtually.1 This switch to virtual environments has enabled broader access to diverse voices not typically represented at the conference table, reduced cost barriers and visa requirements, and exemplified the efficiency and effectiveness of virtual meetings. Inequity in the participation of in-person conferences Travel to and from conferences is typically both expensive and carbon-intensive, often dominated by the Global North, perpetuating existing power imbalances within global health, and possibly leaving a higher burden on the shoulders of attendees from specific geographical locations and socioeconomic, gender and ethnic backgrounds.4 5 At the same time, the carbon-intensive nature of this travel raises questions around planetary health impacts.4 Participation in global health convenings, such as WHAs over the past 74 years, has historically been inequitable, with limited representation of attendees from specific geographical locations—particularly lower-middle income countries (LMICs)—and those from certain socioeconomic, gender and ethnic backgrounds.1 Illustratively, a recent review of 112 global health conferences found that LMIC attendees are often under-represented in global health conferences due to systematic barriers that include visa restrictions (disproportionately stringent requirements and complex procedures), financial barriers (high overall costs of travel, stay and visas), political barriers (eg, corruption at local embassies, regional conflicts or epidemics, the fear of host countries that attendees do not plan to leave), or cases of discrimination and racism (on the basis of nationality and ‘weaker’ passport status).1 These findings can similarly be extended to participation at the WHA, annually held in Geneva, Switzerland, where attendees from approximately 150 countries require a visa,6 and significant financial means for travel and subsistence for up to 2 weeks, in a city that ranks seventh in the top 10 of the Worldwide Cost of Living Index.7 In particular, attendees from LMICs disproportionately have to undergo time-intensive and costly processes when applying for a visa, without having any guarantee that the visa will be granted or that there is an opportunity to re-apply. Emissions are generated by both air and land travel, hospitality services, single-use conference items (eg, badges, water bottles), the provision of unsustainable dietary choices in the conference menus,9 manufacturing of conference items (eg, tote bags, USB sticks), the increased use of electricity and use of audio-visual equipment.10 Nevertheless, a large portion of these emissions can be traced back to travel, including modes, frequency and distance. [...]threats to food and water security undermine the social and physical determinants of good health.17 18 Importantly, the effects of climate change on health—both incremental and disastrous—are often unequal.19 20 The populations being disproportionately impacted have historically contributed the least to the problem, and largely comprise racial and ethnic minorities including Indigenous people, women and gender minorities, and the Global South.20 This dynamic is mirrored by ‘global health meeting inequity’, where those that often suffer from the largest proportion of the global burden of disease are under-represented at global health fora and decision-making tables, such as the WHA.

Assessment. A hand hygiene station with an RFID reader and dispensing sensor recorded the nametag nearest to the station at the time of use. Mean frequency of use per student was 5.41 (range: 2-10). Distance between the student's seat and the dispenser was the only variable significantly associated with adherence. Student satisfaction with the system was assessed by a self-administered survey at the end of the study. Most students reported that the system increased their motivation to perform hand hygiene as indicated.