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There is evidence that persons with disabilities often encounter grave barriers when accessing sexual and reproductive health services. To the best of our knowledge, however, no systematic review has been conducted to pull together these pieces of research evidence for us to understand the nature, magnitude and extent of these barriers in different settings in sub-Saharan Africa. We do not yet have a good understanding of the strength/quality of the evidence that exist on the barriers persons with disabilities face when accessing sexual and reproductive health services in sub-Saharan Africa. We therefore conducted a systematic review to examine the barriers persons with disabilities face in accessing sexual and reproductive health services in sub-Saharan Africa. A systematic review was conducted using PRISMA guidelines (PROSPEROO protocol registration number: CRD42017074843). An electronic search was conducted in Medline, EMBASE, CINAHL, PsycINFO, and Web of Science from 2001 to 2020. Manual search of reference list was also conducted. Studies were included if they reported on barriers persons with disability face in accessing sexual and reproductive health services. The Critical Appraisal Skills Programme and Centre for Evidence Based Management (CEBMa) appraisal tools were used to assess methodological quality of eligible studies. A total of 1061 studies were identified. Only 26 studies covering 12 sub-Saharan African countries were eligible for analysis. A total of 33 specific barriers including inaccessible physical health infrastructure and stigma and discrimination were identified. These barriers were further categorised into five levels: broader national level barriers; healthcare system/institutional barriers; individual level barriers; community level barriers; and economic barriers. Persons with disabilities face a myriad of demand and supply side barriers to accessing sexual and reproductive healthcare in sub-Saharan Africa. Multilevel interventions are urgently needed to address these barriers.

While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling's thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers' insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare providers as well as the provision of disability-friendly transport and healthcare facilities and services are needed.

Globally, less safe or least safe abortion among adolescents remains a public health concern. In Ghana, complications from less safe and least safe abortions result in approximately 43,000 facility-based post-abortion care cases annually, contributing significantly to the overall burden of maternal morbidity and mortality. Healthcare workers play a critical role in delivering comprehensive abortion care (CAC) services to address the challenges of less safe and least safe abortion. At the same, there is scanty literature in Ghana on the experiences of these healthcare workers. This study explored the experiences of healthcare workers in providing CAC to adolescents in the New Juaben Municipality in Eastern Region, Ghana. A phenomenological qualitative study was conducted. Data were collected from November 2022 to January 2023 among 12 healthcare providers. Prior to data collection, ethical approval was obtained from the Ghana Health Service (GHS) Ethics Review Committee (GHS-ERC: 039/11/22). Participants who had provided CAC services for at least 6 months were purposively sampled. In-depth interviews were conducted and audio-recorded with permission from participants. The interviews were transcribed verbatim and inductive thematic analysis was done using ATLAS. ti. Results were presented using quotes. Three main themes emerged, namely desire to minimize harm, attitudes and beliefs toward CAC provision for adolescents, and stigma and psychosocial impacts of providing CAC services. First, providers offered CAC to adolescents to reduce maternal morbidity and mortality, viewing their work as life-saving and a way to prevent less safe and least safe abortions and promote contraceptive use. Second, providers' attitudes and beliefs were shaped by professional duty, personal discomfort, religious and moral dilemmas, and empathy for adolescents' vulnerability. Third, stigma and psychosocial impacts influenced their experiences. Many faced judgments from colleagues and society, leading to emotional distress and, in some cases, psychological trauma. The experiences of healthcare providers in delivering CAC to adolescents in the New Juaben Municipality reflect a complex interplay of professional responsibilities/ obligations, national health policy requirements, personal and religious beliefs, and societal stigma. Addressing these challenges requires coordinated and targeted interventions. These include institutionalizing values clarification and attitude transformation (VCAT) training, integrating cultural competence into provider education, and ensuring legal and ethical accountability that emphasizes patient safety over personal beliefs. Structured mentorship and peer support programs are also essential to reduce emotional burden and sustain provider motivation. Expanding task sharing to include other trained cadres can enhance service continuity and retention. Finally, strengthening public education on safe abortion care is critical to destigmatizing CAC and fostering an environment where providers can deliver adolescent-centered care effectively.

Globally, little evidence exists on transmission patterns of COVID-19. Recommendations to prevent infection include appropriate and frequent handwashing plus physical and social distancing. We conducted an exploratory observational study to assess compliance with these recommendations in selected transportation stations in Ghana. A one-hour audit of 45 public transport stations in the Greater Accra region was carried out between 27th and 29th March 2020. Using an adapted World Health Organization (WHO) hand hygiene assessment scale, the availability and use of handwashing facilities, social distancing, and ongoing public education on COVID-19 prevention measures were assessed, weighted and scored to determine the level of compliance of stations. Compliance with recommendations was categorized as \"inadequate\" \"basic\", \"intermediate\" and \"advanced\", based on the overall score. Majority (80%) of stations in Accra have at least one Veronica Bucket with flowing water and soap, but the number of washing places at each station is not adequate. Only a small minority (18%) of stations were communicating the need to wash hands frequently and appropriately, and to practice social/physical distancing while at the station. In most stations (95%), hand washing practice was either not observed, or only infrequently. Almost all stations (93%) did not have alcohol-based hand sanitizers available for public use, while social distancing was rarely practiced (only 2%). In over 90% of the stations, face masks were either not worn or only worn by a few passengers. Compliance with COVID-19 prevention measures was inadequate in 13 stations, basic in 16 stations, intermediate in 7 stations, and advanced in 9 stations. Compliance with COVID-19 prevention measures in public transportation stations in the Greater Accra region remains a challenge. Awareness creation should aim to elevate COVID-19 risk perception of transportation operators and clients. Transport operators and stations need support and guidance to enforce hand washing and social distancing.

Background Infertility presents both medical and public health challenges, with in vitro fertilization (IVF) emerging as a prominent solution, particularly when other alternatives are exhausted. However, IVF treatment raises significant ethical questions that have been under explored in the Ghanaian context. This study aimed to explore ethical constraints and dilemmas in the provision of in vitro fertilization (IVF) treatment in Ghana. Methods A descriptive phenomenological qualitative design was employed. Purposive sampling techniques were used to recruit 12 participants including ART experts from three in vitro fertilization (IVF) centres, ethicists and a legal practitioner. In-depth face-to-face interviews guided by an open-ended interview guide were conducted. Thematic analysis of the interviews was performed to identify major themes. Results Providing IVF treatment in Ghana raises several ethical issues, including inequitable access due to high costs and limited availability, which favour wealthier individuals and leave marginalized populations with fewer options. There are significant ethical considerations in balancing the potential benefits of successful IVF treatment outcomes against the health risks and emotional tolls on patients. Decisions about the fate of surplus embryos present moral dilemmas, including whether to preserve, donate, or discard them. Differing personal beliefs about the moral status of the embryo further complicate the ethical landscape. Ensuring informed consent is challenging due to the complex medical, ethical, and emotional implications of IVF treatment, potentially leading to compromised consent. Additionally, there are ongoing risks of breaches in confidentiality, given the sensitive nature of reproductive health data and the importance of protecting patient privacy. Conclusion This study revealed that several ethical dilemmas confront both healthcare providers and couples in the process of IVF. There is an urgent need for the development of clear and uniform regulations to govern the practice of IVF treatment in Ghana, with further attention given to mitigating financial barriers and enhancing support systems for couples considering IVF treatment.

Inefficient referral systems and limited awareness on the importance of antenatal care (ANC) hinder expectant adolescents and young women from achieving the recommended ANC visits. Mobile health interventions and community-based clinical outreaches have emerged as potential strategies to improve ANC utilization and skilled delivery rates. This study evaluates the effectiveness of mHealth text messaging and community-based clinical outreaches in improving ANC uptake, skilled deliveries, and infants' birthweights among expectant adolescents and young women in Kwale County, Coastal Kenya. A quasi-experimental study was conducted across four public health facilities, comparing three groups: mHealth text messaging intervention, community-based outreaches, and a control group receiving standard care. Multivariate regression models were used to adjust for baseline differences and potential confounders. Key outcomes included ANC attendance, skilled birth attendance, and infant birthweights. A total of 817 participants were included in the analysis. Participants in the mHealth (RR: 0.5 [95% CI: 0.4-0.7], p < 0.001) and outreach arms (RR: 0.1 [95% CI: 0.0-0.7], p = 0.024), had significantly lower risk of low ANC contacts compared to the control arm participants. Similarly, the odds of unskilled deliveries were significantly lower in the mHealth (OR: 0.2 [95% CI: 0.1-0.4, p < 0.001] and the outreach arms (OR: 0.1 [95% CI: 0.0-0.6], p = 0.007), compared to the control group. Notably, infants born to participants in the mHealth-text message intervention (OR: 5.9 [95% CI: 1.7-20.8, p = 0.006]) and outreach arms (OR: 6.6 [95% CI: 1.7-25.7], p = 0.007) had significantly higher odds of low birth weight, compared to those born to control arm participants. Both mHealth-text messaging and community-based clinical outreaches can improve antenatal contacts and institutional skilled deliveries. Integrating both strategies can enhance maternal health outcomes for young women in Kenya and should be considered for broader adoption within public health programs to optimize care delivery.

Background Transactional sex has gained public health attention in recent times because of its contributions to sexually transmitted infections and unwanted pregnancy among young women in sub-Saharan Africa. However, empirical data on the extent of this practice are lacking in Ghana. This study provides baseline information on the prevalence of transactional sex practice and associated factors among young women in a tertiary institution in Northern Ghana. Methods A quantitative cross-sectional survey was conducted among 340 sexually active young female students. Stratified and simple random sampling techniques were used to sample respondents. Data were collected online using a pretested questionnaire. The prevalence of transactional sex and other socio-demographic characteristics were analysed descriptively using frequencies and percentages. A logistic regression model was used to determine predictors of transactional sex and assess the links between transaction sex and other risky sexual behaviours. Findings Respondents were aged 18–31 years, and mean age was 24.94 (SD = ± 4.87). The prevalence of ever engaging in transactional sex was 23.8%, and 16.8% reported engaging in transactional sex in the past 12 months prior to the study. Nearly 65% of those who reported engaging in transactional sex in the last 12 months have done so at least four times. The odds of engaging in transactional sex were lower among older respondents (AOR: 0.140, 95%, CI: 0.032–0.605, p  = 0.008); but higher for early sexual debut (AOR: 2.745, 95%, CI: 1.068–7.060, p  = 0.036), area of residence (i.e. being peri-urban) (AOR: 8.300, 95%, CI: 1.655–41.617, p  = 0.010), insufficient family support (AOR: 5.903, 95%, CI: 1.515–23.006, p  = 0.011), and frequently using at least two social media applications (AOR: 3.893, 95%, CI: 1.276–11.877, p  = 0.017). Respondents who engaged in transactional sex reported higher odds of contracting STIs (AOR: 3.580, CI:1.059–12.099, p 0.040), and having an abortion (AOR: 2.616, CI: 1.037–6.598, p 0.042) in the last 12 months. Conclusion Targeted comprehensive sexual and reproductive health and rights education interventions are needed on the campuses of institutions of higher learning to enable young women negotiate safe sex and sexual relationships. In addition, there is need to promote contraceptive use (especially those that offer dual protection) among young women on the campuses of tertiary institutions to minimise STIs infection and unwanted pregnancy. Economic empowerment programmes such cash transfers to identifiable impoverished female students, scholarships and grant opportunities and discounted fees would also be critical to preventing and/ or minimising the occurrence of transactional sex among young women.

Background The importance of men's involvement in facilitating women’s access to skilled maternal healthcare in patriarchal societies such as Ghana is increasingly being recognised. However, few studies have been conducted to examine men’s involvement in issues of maternal healthcare, the barriers to men’s involvement, and how best to actively involve men. The purpose of this paper is to explore the barriers to and opportunities for men’s involvement in maternal healthcare in the Upper West Region of Ghana. Methods Qualitative focus group discussions, in-depth interviews and key informant interviews were conducted with adult men and women aged 20–50 in a total of seven communities in two geographic districts and across urban and rural areas in the Upper West Region of Ghana. Attride-Stirling’s thematic network analysis framework was used to analyse and present the qualitative data. Results Findings suggest that although many men recognise the importance of skilled care during pregnancy and childbirth, and the benefits of their involvement, most did not actively involve themselves in issues of maternal healthcare unless complications set in during pregnancy or labour. Less than a quarter of male participants had ever accompanied their wives for antenatal care or postnatal care in a health facility. Four main barriers to men’s involvement were identified: perceptions that pregnancy care is a female role while men are family providers; negative cultural beliefs such as the belief that men who accompany their wives to receive ANC services are being dominated by their wives; health services factors such as unfavourable opening hours of services, poor attitudes of healthcare providers such as maltreatment of women and their spouses and lack of space to accommodate male partners in health facilities; and the high cost associated with accompanying women to seek maternity care. Suggestions for addressing these barriers include community mobilisation programmes to promote greater male involvement, health education, effective leadership, and respectful and patient-centred care training for healthcare providers. Conclusions The findings in this paper highlight the need to address the barriers to men’s involvement, engage men and women on issues of maternal health, and improve the healthcare systems – both in terms of facilities and attitudes of health staff - so that couples who wish to be together when accessing care can truly do so.

Introduction Globally, less safe or least safe abortion among adolescents remains a public health concern. In Ghana, complications from less safe and least safe abortions result in approximately 43,000 facility-based post-abortion care cases annually, contributing significantly to the overall burden of maternal morbidity and mortality. Healthcare workers play a critical role in delivering comprehensive abortion care (CAC) services to address the challenges of less safe and least safe abortion. At the same, there is scanty literature in Ghana on the experiences of these healthcare workers. This study explored the experiences of healthcare workers in providing CAC to adolescents in the New Juaben Municipality in Eastern Region, Ghana. Methods A phenomenological qualitative study was conducted. Data were collected from November 2022 to January 2023 among 12 healthcare providers. Prior to data collection, ethical approval was obtained from the Ghana Health Service (GHS) Ethics Review Committee (GHS-ERC: 039/11/22). Participants who had provided CAC services for at least 6 months were purposively sampled. In-depth interviews were conducted and audio-recorded with permission from participants. The interviews were transcribed verbatim and inductive thematic analysis was done using ATLAS. ti. Results were presented using quotes. Findings Three main themes emerged, namely desire to minimize harm, attitudes and beliefs toward CAC provision for adolescents, and stigma and psychosocial impacts of providing CAC services. First, providers offered CAC to adolescents to reduce maternal morbidity and mortality, viewing their work as life-saving and a way to prevent less safe and least safe abortions and promote contraceptive use. Second, providers’ attitudes and beliefs were shaped by professional duty, personal discomfort, religious and moral dilemmas, and empathy for adolescents’ vulnerability. Third, stigma and psychosocial impacts influenced their experiences. Many faced judgments from colleagues and society, leading to emotional distress and, in some cases, psychological trauma. Conclusion The experiences of healthcare providers in delivering CAC to adolescents in the New Juaben Municipality reflect a complex interplay of professional responsibilities/ obligations, national health policy requirements, personal and religious beliefs, and societal stigma. Addressing these challenges requires coordinated and targeted interventions. These include institutionalizing values clarification and attitude transformation (VCAT) training, integrating cultural competence into provider education, and ensuring legal and ethical accountability that emphasizes patient safety over personal beliefs. Structured mentorship and peer support programs are also essential to reduce emotional burden and sustain provider motivation. Expanding task sharing to include other trained cadres can enhance service continuity and retention. Finally, strengthening public education on safe abortion care is critical to destigmatizing CAC and fostering an environment where providers can deliver adolescent-centered care effectively.