Active military service may heighten a woman’s risk of having a low birthweight baby, suggests a review of the available scientific evidence published online in the journal BMJ Military Health.
The findings highlight the need for more research specifically focused on women in the armed forces, and their reproductive health in particular, conclude the study authors.
Worldwide, increasing numbers of women are on active service in their country’s armed forces. The UK Armed Forces, for example, has set a target of 30% female representation by 2030. And more and more countries are deploying women in combat units, and in other challenging environments, such as submarines, note the study authors.
Mounting evidence suggests that stress experienced during pregnancy is associated with birth complications, such as preterm delivery and low birthweight. And a military career and lifestyle expose service personnel to a wide range of physical, mental, and environmental stressors that could potentially influence pregnancy outcomes.
The study authors therefore wanted to explore the potential impact of active military service on the risks of preterm labour and birth, low birthweight, and stillbirth.
They scoured research databases for relevant studies, and included 21 that met all the eligibility criteria in their analysis. The studies, which involved 650,628 women serving in the US military, were all published between 1979 and 2023.
Ten of the studies included a comparison group—usually the wives of active service personnel. By way of a proxy for those that didn’t include a comparator, the study authors drew on national data from the US National Vital Statistics for any given year.
Analysis of the study results indicated no heightened risk of preterm birth among pregnant active service women. But there were significant methodological differences; most studies had a moderate to high risk of bias; and several included only small sample sizes, caution the study authors.
There was no observed association between branch of military service and increased risk of preterm birth, although again this should be interpreted cautiously as 5 studies included mixed service samples and the study design varied considerably, say the study authors.
There was no clear evidence for an increased risk of stillbirth among women on active military service, either.
But nearly two thirds (62.5%) of the studies concluded that women on active service may be at heightened risk of having a low birthweight baby, including one study with the lowest risk of bias. And 4 of the 5 studies that included a comparison group also indicated an increased risk of low birthweight.
Seven of the 8 studies reporting on low birthweight were carried out in single-service settings. Both of those from the US Air Force suggested a higher prevalence of low birthweight babies born to active duty military personnel.
But some 53% and 38% of the studies reporting on preterm birth and low birthweight, respectively, didn’t have a matched comparison group and relied on a proxy drawn from national statistical data.
This introduces a risk of systematic error as the baseline characteristics of the two groups are inherently different, caution the study authors.
Women on active military service will also be medically screened before any tours of duty and will have fewer co existing conditions, while national data will include high risk and multiple pregnancies, they explain.
Only observational studies were included in the review, and the data collection methods and/or adjustment for influential factors varied, acknowledge the study authors. Only 8 studies reported on smoking status despite a high prevalence of smoking in the military and the fact that smoking is associated with several health issues before and during pregnancy.
The data also focused exclusively on the US military, which although unsurprising given that it is one of the largest in the world, this does limit the generalisability of the findings to armed forces personnel elsewhere, highlight the study authors.
Nevertheless, they conclude: This review highlights a need for more female-specific research in armed forces, beyond the US military setting, to inform military maternity pathways and policies in ways that safeguard mothers and their babies while enhancing military readiness.”
Source:
Journal reference:
Morris, K. A. L., & McKee, M. (2024). Effect of active-duty military service on neonatal birth outcomes: a systematic review. BMJ Mil Health. doi.org/10.1136/military-2023-002634.
California state lawmakers this year are continuing their progressive tilt on health policy with dozens of proposals including a ban on a Froot Loops ingredient and free condoms for high schoolers.
As states increasingly fracture along partisan lines, California Democrats are stamping their supermajority on legislation that they will consider until they adjourn at the end of August. But the cost of these proposals will be a major factor given the enormity of the state’s deficit, currently estimated at between $38 billion and $73 billion.
Health coverage
Lawmakers are again considering whether to create a government-run, single-payer health care system for all Californians. AB 2200 is Democratic Assembly member Ash Kalra’s second such attempt, after a similar bill failed in 2022. The price tag would be enormous, though proponents say there would also be related savings. The high potential cost left Assembly Speaker Robert Rivas and others skeptical it could become law while the state faces a deficit.
AB 4 would require Covered California, the state’s health insurance exchange, to offer health insurance policies to people who are otherwise not able to obtain coverage because of their immigration status, to the extent it can under federal law. That could eventually lead to subsidized insurance premiums similar to those offered in Colorado and Washington.
Medical debt
Health care providers and collection agencies would be barred from sharing patients’ medical debt with credit reporting agencies under SB 1061. The bill would also prohibit credit reporting agencies from accepting, storing, or sharing any such information without consumer consent. Last year, the Biden administration announced plans to develop federal rules barring unpaid medical bills from affecting patients’ credit scores. California would be the third state to remove medical bills from consumer credit reports.
The Medi-Cal program, which provides health care for low-income people, would be required to cover medically supportive food and nutrition starting July 1, 2026, under AB 1975. The bill builds on an existing but limited pilot program. The legislation says Californians of color could benefit from adequate food and nutrition to combat largely preventable chronic health conditions, and it’s one of 14 measures sought by the California Legislative Black Caucus as part of reparations for racial injustice.
More than 1.6 million California residents, disproportionately Latinos, have been kicked off Medi-Cal since the state resumed annual eligibility checks that were halted during the covid-19 pandemic. AB 2956 would have the state seek federal approval to slow those disenrollments by taking steps such as letting people 19 and older keep their coverage automatically for 12 months.
Violence prevention
An increase in attacks on health workers is prompting lawmakers to consider boosting criminal penalties. In California, simple assault against workers inside an ER is considered the same as simple assault against almost anyone else, and carries a maximum punishment of a $1,000 fine and six months in jail. In contrast, simple assault against emergency medical workers in the field, such as an EMT responding to a 911 call, carries maximum penalties of a $2,000 fine and a year in jail. AB 977 would set the same maximum penalties for assaulting emergency health care workers on the job, whether they are in the field or an ER.
California could toughen penalties for interfering with reproductive health care services. Posting personal information or photographs of a patient or provider would be a felony if one of them is injured as a result. AB 2099 also boosts penalties for intimidation or obstruction.
Under SB 53, gun owners would have to lock up their weapons in state-approved safes or lockboxes where they would be inaccessible to anyone but the owner or another lawfully authorized user. Democratic Sen. Anthony Portantino, the bill’s author, says that would make it tougher for anyone, including children, to use guns to harm themselves or others or use the weapons to commit crimes. Critics say it would make it harder to access the weapon when it’s needed, such as to counter a home invasion. Relatedly, AB 2621 and AB 2917 address gun violence restraining orders.
Substance use
The spike in drug overdoses has prompted several responses: AB 3073 would require the state’s public health department to partner with local public health agencies, wastewater treatment facilities, and others to pilot wastewater testing for traces of dangerous drugs in an effort to pinpoint drug hot spots and identify new drugs. AB 1976 would require workplace first-aid kits to include naloxone nasal spray, which can reverse opioid overdoses. And senators have proposed at least nine bills aimed at curbing overdose deaths, particularly from the deadly synthetic opioid fentanyl.
Youth welfare
Under AB 2229, backed by a “Know Your Period” campaign, school districts’ sex education curricula would have to include menstrual health. There was no registered opposition.
Public schools would have to make free condoms available to all pupils in grades nine to 12 under SB 954, which would help prevent unwanted pregnancies and sexually transmitted infections, according to the author, Democratic Sen. Caroline Menjivar. Democratic Gov. Gavin Newsom vetoed a similar bill last year.
Reality show star Paris Hilton is backing a bipartisan bill to require more reporting on the treatment of youth in state-licensed short-term residential therapeutic programs. SB 1043 would require the state Department of Social Services to post information on the use of restraints and seclusion rooms on a public dashboard.
California would expand its regulation of hemp products, which have become increasingly popular among youths as a way to bypass the state’s adults-only restrictions on legal cannabis. AB 2223 would build on a 2021 law that Assembly member Cecilia Aguiar-Curry said in hindsight didn’t go far enough.
Public schools would, under AB 2316, generally be barred from providing food containing red dye 40, titanium dioxide, and other potentially harmful substances, which are currently used in products including Froot Loops and Flamin’ Hot Cheetos. It’s Democratic Assembly member Jesse Gabriel’s follow-up to his legislation last year that attempted to ban a chemical used in Skittles.
Women’s health
AB 2515 would ban the sale of menstrual products with intentionally added PFAS, also known as “forever chemicals.” PFAS, short for perfluoroalkyl and polyfluoroalkyl substances, have been linked to serious health problems. Newsom vetoed a previous attempt.
Social media
Social media companies could face substantial penalties if they don’t do enough to protect children, under AB 3172. The measure would allow financial damages of up to $1 million for each child under age 18 who proves in court they were harmed, or three times the amount of the child’s actual damages. The industry opposes the bill, calling it harmful censorship.
Cyberbullies could face civil liabilities up to $75,000 under SB 1504, and those damages could be sought by anyone. Under current law, damages are capped at $7,500 and may be pursued only by the state attorney general.
Wellness
Bosses could be fined for repeatedly contacting employees after working hours under AB 2751, a “right to disconnect” bill patterned after similar restrictions in 13 countries. The bill’s author, Democratic Assembly member Matt Haney, said despite the advent of smartphones that “have blurred the boundaries between work and home life,” employees shouldn’t be expected to work around the clock. The measure is opposed by the California Chamber of Commerce.
Finally, Democrat Anthony Rendon, a long-serving state Assembly speaker, is spending his last year in the chamber leading a first-in-the-nation Select Committee on Happiness and Public Policy Outcomes. The committee isn’t planning any legislation but intends to issue a report after lawmakers adjourn in August.
This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.
Abortion opponents have maneuvered in courthouses for years to end access to reproductive health care. In Arizona last week, a win for the anti-abortion camp caused political blowback for Republican candidates in the state and beyond.
The reaction echoed the response to an Alabama Supreme Court decision over in vitro fertilization just two months before.
The election-year ruling by the Arizona Supreme Court allowing enforcement of a law from 1864 banning nearly all abortions startled Republican politicians, some of whom quickly turned to social media to denounce it.
The court decision was yet another development forcing many Republicans legislators and candidates to thread the needle: Maintain support among anti-abortion voters while not damaging their electoral prospects this fall. This shifting power dynamic between state judges and state lawmakers has turned into a high-stakes political gamble, at times causing daunting problems, on a range of reproductive health issues, for Republican candidates up and down the ballot.
When the U.S. Supreme Court said give it back to the states, OK, well now the microscope is on the states. We saw this in Alabama with the IVF decision,” she said, “and now we’re seeing it in Arizona.”
Jennifer Piatt, co-director of the Center for Public Health Law and Policy at Arizona State University’s Sandra Day O’Connor College of Law
Multiple Republicans have criticized the Arizona high court’s decision on the 1864 law, which allows abortion only to save a pregnant woman’s life. “This decision cannot stand. I categorically reject rolling back the clock to a time when slavery was still legal and where we could lock up women and doctors because of an abortion,” state Rep. Matt Gress said in a video April 9. All four Arizona Supreme Court justices who said the long-dormant Arizona abortion ban could be enforced were appointed by former Gov. Doug Ducey, a Republican who in 2016 expanded the number of state Supreme Court justices from five to seven and cemented the bench’s conservative majority.
Yet in a post the day of the ruling on the social platform X, Ducey said the decision “is not the outcome I would have preferred.”
The irony is that the decision came after years of efforts by Arizona Republicans “to lock in a conservative majority on the court at the same time that the state’s politics were shifting more towards the middle,” said Douglas Keith, senior counsel at the left-leaning Brennan Center for Justice.
All the while, anti-abortion groups have been pressuring Republicans to clearly define where they stand.
“Whether running for office at the state or federal level, Arizona Republicans cannot adopt the losing ostrich strategy of burying their heads in the sand on the issue of abortion and allowing Democrats to define them,” Kelsey Pritchard, a spokesperson for Susan B. Anthony Pro-Life America, said in an emailed statement. “To win, Republicans must be clear on the pro-life protections they support, express compassion for women and unborn children, and contrast their position with the Democrat agenda.”
Two months before the Arizona decision, the Alabama Supreme Court said frozen embryos from in vitro fertilization can be considered children under state law. The decision prompted clinics across the state to halt fertility treatments and caused a nationwide uproar over reproductive health rights. With Republicans feeling the heat, Alabama lawmakers scrambled to pass a law to shield IVF providers from prosecution and civil lawsuits “for the damage to or death of an embryo” during treatment.
But when it comes to courts, Arizona lawmakers are doubling down: state Supreme Court justices are appointed by the governor but generally face voters every six years in retention elections. That could soon change. A constitutional amendment referred by the Arizona Legislature that could appear on the November ballot would eliminate those regular elections — triggering them only under limited circumstances — and allow the justices to serve as long as they exhibit “good behavior.” Effectively it would grant justices lifetime appointments until age 70, when they must retire.
Even with the backlash against the Arizona court’s abortion decision, Keith said, “I suspect there aren’t Republicans in the state right now who are lamenting all these changes to entrench a conservative majority on the Supreme Court.”
Meanwhile, abortion rights groups are trying to get a voter-led state constitutional amendment on the ballot that would protect abortion access until fetal viability and allow abortions afterward to protect the life or health of the pregnant person.
State court decisions are causing headaches even at the very top of the Republican ticket. In an announcement in which he declined to endorse a national abortion ban, presumptive Republican presidential nominee Donald Trump on April 8 said he was “proudly the person responsible” for ending Roe v. Wade, which recognized a federal constitutional right to abortion before being overturned by the U.S. Supreme Court in 2022, and said the issue should be left to states. “The states will determine by vote or legislation, or perhaps both, and whatever they decide must be the law of the land,” he said. But just two days later he sought to distance himself from the Arizona decision. Trump also praised the Alabama Legislature for enacting the law aiming to preserve access to fertility treatments. “The Republican Party should always be on the side of the miracle of life,” he said.
Recent court decisions on reproductive health issues in Alabama, Arizona, and Florida will hardly be the last. The Iowa Supreme Court, which underwent a conservative overhaul in recent years, on April 11 heard arguments on the state’s near-total abortion ban. Republican Gov. Kim Reynolds signed it into law in 2023 but it has been blocked in court.
In Florida, there was disappointment all around after dueling state Supreme Court decisions this month that simultaneously paved the way for a near-total abortion ban and also allowed a ballot measure that would enshrine abortion rights in the state constitution to proceed.
The Florida high court’s decisions were “simply unacceptable when five of the current seven sitting justices on the court were appointed by Republican Governor Ron DeSantis,” Andrew Shirvell, executive director of the anti-abortion group Florida Voice for the Unborn, said in a statement. “Clearly, grassroots pro-life advocates have been misled by elements within the ‘pro-life, pro-family establishment’ because Florida’s highest court has now revealed itself to be a paper tiger when it comes to standing-up to the murderous abortion industry.”
Tension between state judicial systems and conservative legislators seems destined to continue given judges’ growing power over reproductive health access, Piatt said, with people on both sides of the political aisle asking: “Is this a court that is potentially going to give me politically what I’m looking for?”
This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.
Companies have increasingly offered generous fertility benefits to attract and keep top-notch workers. Now, the federal government is getting in on the act. Starting this year, federal employees can choose plans that cover several fertility services, including up to $25,000 annually for in vitro fertilization procedures and up to three artificial insemination cycles each year.
With about 2.1 million civilian employees, the federal government is the nation’s largest employer. Now, just as businesses of every stripe prioritize fertility benefits, in vitro fertilization — a procedure in use for more than 40 years — has become a tricky topic for some anti-abortion Republican members of Congress and even presidential candidates.
It was inevitable that disagreements over IVF among abortion opponents would eventually break into the open, said Mary Ziegler, a legal historian and expert on reproductive health.
“The anti-abortion movement from the 1960s onward has been a fetal personhood movement,” said Ziegler, a law professor at the University of California-Davis. Since the U.S. Supreme Court’s Dobbs decision eliminated the constitutional right to abortion, anti-abortion groups and the Republican Party are grappling with what “fetal personhood” means and how that fits into their position on IVF and other technologies that help people have babies.
The Alabama Supreme Court set the stage for the recent brouhaha with a ruling last month that frozen embryos created through IVF are children under state law. A pair of Democratic senators advanced legislation that would override state laws by establishing a statutory right to access IVF and other such technologies. The bill was blocked on the Senate floor by a Republican opponent.
These events highlight the tough spot in which Republicans find themselves. Many support IVF, and they are keenly aware that it’s extremely popular: 86% of adults in a recent CBS News-YouGov poll said IVF should be legal. The outcry over the Alabama ruling and Republicans’ inability to coalesce around a federal response, however, has exposed fault lines in the party.
Some anti-abortion groups have strenuously objected to measures like that Senate bill, arguing that lawmakers must balance IVF with the responsibility to respect life.
Republicans “are trying to finesse it, which is very hard,” Ziegler said.
About 10% of women and men face fertility problems, according to the National Institute of Child Health and Human Development. IVF, a process in which an egg is fertilized in a laboratory and later implanted in the uterus, is among the most expensive fertility treatments, costing about $20,000 for one round. Even with insurance coverage, the procedure is pricey, but for some people it’s the only way to conceive.
In recent years, the number of companies offering fertility benefits to employees has grown steadily. In the early 2000s, fewer than a quarter of employers with at least 500 workers covered IVF, according to benefits consultant Mercer’s annual employer survey. In 2023, that figure had roughly doubled, to 45%. Employers typically cap IVF benefits. In 2023, employers had a median lifetime maximum benefit of $20,000 for IVF, according to the Mercer survey.
The federal government’s IVF benefit — paying up to $25,000 a year — is more generous than that of a typical employer. Coverage is available through the popular Blue Cross and Blue Shield Federal Employee Program’s standard option. Altogether, two dozen 2024 health plans for federal workers offer enhanced IVF coverage, with varying benefits and cost sharing, according to the federal Office of Personnel Management, which manages the federal health plans.
“OPM’s mission is to attract and retain the workforce of the future,” said Viet Tran, OPM’s press secretary, in written answers to questions. He noted that surveys have found that federal health benefits have influenced employees’ decisions to stay with the federal government.
Starting this year, plans offered to federal employees are required to offer fertility benefits, according to OPM.
But it’s unclear how the emerging political debate surrounding IVF and other reproductive health issues could affect national benefit and coverage trends.
Last month, after the Alabama Supreme Court ruled that frozen embryos left over following IVF procedures are considered children under state law, the state legislature quickly passed and Republican Gov. Kay Ivey signed a bill that grants immunity to patients and providers who participate in IVF services. During the ensuing dust-up, a coalition of more than a dozen anti-abortion groups signed a letter drawing a clear line in the sand. “Both science and logic have made it clear that embryos must be accorded the same human rights” as other human beings, it read. The Alabama law didn’t address the underlying issue of the “personhood” of the embryos, leaving open the door for further litigation and potential restrictions on IVF in Alabama and other states, some legal analysts say.
More than a third of states have laws on the books that classify fetuses as people at some stage of pregnancy, according to an analysis by Politico.
It’s unclear whether the turmoil surrounding the Alabama case will have long-term repercussions for employee benefits there or in other states.
“If this were something that were to happen in multiple states, employers would have to figure out how to navigate around that,” said Jim Winkler, chief strategy officer of the Business Group on Health, a nonprofit that represents the interests of large employers. At this point, employers will want to keep a watchful eye on the issue but probably not plan any changes, Winkler said.
A Mercer blog post advised businesses with Alabama employees to review health plan policies related to medical travel and leave benefits. Further, “employers should monitor other states that broadly define fetal personhood and restrict reproductive healthcare,” the blog post advised.
The situation is reminiscent of what happened with abortion coverage following the Supreme Court’s Dobbs decision in 2022. As states imposed restrictions on access to abortions, many companies began providing travel expenses for their workers to seek them.
But what happened with abortion may not be a good predictor of what will happen with IVF, said Dorianne Mason, director of health equity at the National Women’s Law Center.
Following the Alabama judge’s ruling, “the legislature in Alabama moved so quickly to respond to the outcry,” Mason said. “When we look at the legislative response to IVF, it’s moving in a markedly different direction on access to care” than has occurred with other types of reproductive care.
This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.
In this insightful interview from SLAS 2024, we talk with Dr. Abidemi Junaid, a scientist at the Hansjörg Wyss Institute for Biologically Inspired Engineering at Harvard University. Junaid spearheads the development of the human Vagina Chip, a pioneering tool designed to study host-microbiome interactions in bacterial vaginosis and pave the way for biotherapeutic development and validation.
With a rich background in biometrics, systems biomedicine, and pharmacology, Junaid’s interdisciplinary approach has culminated in the creation of a model that closely replicates the human vaginal environment. Here, Junaid shares insights into the challenges and triumphs of simulating the female reproductive system on a chip, the implications for women’s health research, and the future of biotherapeutic strategies beyond bacterial vaginosis.
Firstly, please introduce yourself and outline your career to date. More specifically, please provide us with an outline of the research you are presenting on a human Vagina Chip to study host-microbiome interactions in bacterial vaginosis for biotherapeutic development and validation here at SLAS.
My name is Abidemi Junaid, and I am a scientist at Hansjörg Wyss Institute for Biologically Inspired Engineering at Harvard University. I lead the overall effort on the advancement of preclinical testing and modeling of the human reproductive tract using organ-on-chip technology.
The reproductive health of a woman is strongly associated with a vaginal microbiome mainly composed of Lactobacillus species. In contrast, dysbiosis decreases this population and increases the diversity of anaerobic species, including pathogens, such as Garderenella vaginalis, as seen in bacterial vaginosis (BV).
BV increases the risk of pre-term birth, miscarriages, and the chances of acquiring sexually transmitted diseases. Various therapeutic strategies are being explored to modulate the composition of the vaginal microbiome; however, there is no human-relevant preclinical model that faithfully reproduces the vaginal epithelial microenvironment for validation of potential therapeutics.
At SLAS, I will describe our human Vagina Chip that is lined by hormone-sensitive, primary vaginal epithelium interfaced with underlying stromal fibroblasts, which sustains a low physiological oxygen concentration in the epithelial lumen.
The Vagina Chip allows us to study a human model of the vaginal microbiome and develop new treatments for BV and other conditions that threaten women’s health.
Firstly, for our readers, please could you tell us more about what organ-on-a-chip technologies are, and more specifically about the benefits of the human vagina chip compared to that of an animal model?
Organs-on-chips (OoCs) are systems containing engineered or natural miniature tissues grown inside microfluidic chips. To better mimic human physiology, the chips are designed to control cell microenvironments and maintain tissue-specific functions.
Animal models are of limited use in research to study host-microbiota interactions in the vaginal space because of the major physiological, anatomical, and microbial differences present in these models compared to the human vagina. The Vagina Chip replicates the human vaginal tissue microenvironment including its microbiome in vitro.
Image Credit: Love Employee/Shutterstock.com
How does the vagina chip technology simulate the unique environment of the female reproductive system, and what are its applications in women’s health research?
The Vagina Chip supports the growth of healthy microbiome community on-chip, which is accompanied by maintenance of epithelial cell viability, accumulation of D- and L-lactic acid, maintenance of a physiologically relevant low pH, and down regulation of proinflammatory cytokines.
The Vagina Chip can be used to better understand interactions between the vaginal microbiome and host tissues, as well as to evaluate the safety and efficacy of live biotherapeutics products.
What is organ-on-a-chip technology?
Your journey from biometrics to systems biomedicine and pharmacology is quite impressive. Could you share how your diverse academic background has influenced your approach to your current research on the human Vagina Chip?
My interdisciplinary background has allowed me to apply various elements from engineering, chemistry, and biology in the further development of the human Vagina Chip to recapitulate the human vagina for biotherapeutic studies successfully.
During my Ph.D., I learned how to use the high-throughput human microvessels-on-chips for screening patient samples and drug discovery. I was able to use these skills for studying microbes isolated from vaginal clinical swab samples in the Vagina Chip to mimic healthy and dysbiotic conditions.
The Vagina Chip presents a novel approach to studying bacterial vaginosis (BV). Can you describe the initial challenges you faced in replicating the complex vaginal microenvironment on a chip?
One of the initial challenges was getting the cells that we cultured in the Vagina Chip to differentiate and become stratified just like the human vagina. We were able to solve that by using homemade differentiation media and physiologically relevant dynamic flow of media in the system.
Learn more about vaginal dysbiosis
The study indicates that Lactobacillus-rich live biotherapeutic products (LBPs) can alleviate dysbiotic responses without eradicating G. vaginalis. How does this finding challenge or support existing theories about BV treatment?
In a healthy vaginal microbiota, you a have high population of L. crispatus and very low population of G. vaginalis. Since we still see a high population of G. vaginalis after treatment with the LBP in our Vagina Chip, this indicates that additional treatment is needed to reduce the population of G. vaginalis and finally reach a healthy state.
The Vagina Chip’s ability to correlate pro-inflammatory responses with untreated BV patient samples is intriguing. How do you envision this capability impacting the future of personalized medicine for reproductive health?
There is growing recognition that taking care of women’s health is critical for the health of all humans, but the creation of tools to study human female physiology is lagging.
We’re hopeful that this new preclinical model will drive the development of new treatments for BV as well as new insight into female reproductive health. Furthermore, this model will allow us to study individual patients from different ethnicities and develop therapies that is specific to each of them.
You mention that further reduction in G. vaginalis numbers might produce a greater therapeutic effect. What strategies or modifications to the Vagina Chip are being considered to investigate this hypothesis?
One of the strategies that we are trying is to treat the dysbiotic Vagina Chip with hydroxy-metronidazole and the LBP. Hydroxy-Metronidazole is an antibiotic that is commonly used to kill G.vaginalis in BV patients.
However, treating with hydroxy-metronidazole alone can lead to recurrent BV. We hope that with the combination of hydroxy-metronidazole and LBP there is a lower chance of recurrence.
Given the complexity of the vaginal microbiome and its impact on women’s health, how do you see your work influencing the development and validation of other biotherapeutic strategies beyond BV?
Various therapeutic strategies are being explored to modulate the composition of the vaginal microbiome; however, there is no human model that faithfully reproduces the vaginal epithelial microenvironment for preclinical validation of potential therapeutics or testing hypotheses about vaginal epithelium-microbiome interactions.
The Vagina Chip is a preclinical model of the human vaginal mucosa that can be used to understand better interactions between the vaginal microbiome and host tissues, as well as to evaluate the safety and efficacy of live biotherapeutics products. This will help us to predict how successful a biotherapeutic strategy would be in clinical trials.
Finally, as someone at the forefront of organ-on-chip technology, what advice would you give to young scientists interested in entering this field, and what do you think are the most exciting possibilities on the horizon?
The field of organs-on-chips is very interdisciplinary. So, I advise young scientists to explore research in various scientific areas and collaborate with people with different scientific backgrounds.
I look forward to the time when we can fully use organ-on-a-chip technology to replace animal models. Moreover, this technology will be an important tool to decide whether a therapy should go to clinical trial.
Where can readers find more information?
About Abidemi Junaid, Ph.D.
Abidemi Junaid received his B.S. in Biometrics from Zuyd University of Applied Sciences, M.S. in Biomolecular Sciences from VU University, and Ph.D. in Systems Biomedicine and Pharmacology from Leiden University. His Ph.D. work was centered around the development of high-throughput human microvessels-on-chips for studying microvascular destabilization, infectious diseases, and metabolomics.
He also worked on integrating mechanical fluid flow and biological and environmental sensing in organs-on-chips. Altogether, this enabled him to identify the impact of patient plasma on microvessels for clinical studies. As a Scientist at the Wyss Institute, he is working on advancing preclinical testing and modeling of the human immune system using organ-on-chip technology.
The presentation summarized the preliminary findings from patients with known or suspected endometriosis who were imaged with a SPECT-CT camera and subsequently underwent planned laparoscopic surgery, a key-hole surgical procedure to establish the presence, absence and location of endometriotic lesions. The imaging findings were compared to the surgical and histology reports and indicate that 99mTc-maraciclatide holds potential as a non-invasive test for early-stage endometriosis.
Specifically these preliminary findings demonstrate that 99mTc-maraciclatide has the potential to:
Visualize superficial peritoneal endometriosis which is found in the thin peritoneum lining which covers the abdomen and pelvis, and currently can only be identified accurately by surgery. This subtype accounts for c. 80% of all endometriosis diagnoses. In the patients in this study 99mTc-maraciclatide correctly identified superficial peritoneal endometriosis in those who went on to have this early-stage endometriosis confirmed by laparoscopy.
Highlight areas of activity in patients with deep endometriosis (often found on the organs e.g., bladder, bowel, rectum, ovaries) and endometrioma (cysts which are commonly found in the ovaries)
The presentation also outlined a case study on one patient with superficial peritoneal endometriosis which had not been identified by ultrasound, but which had been visualized with 99mTc-maraciclatide, and later confirmed by laparoscopic surgery.
The ongoing study which will recruit 20-25 patients in total is being led by Professor Christian Becker, Co-Director of the Endometriosis CaRe Centre in Oxford, together with Professor Krina Zondervan, Head of Department at the Nuffield Department of Women’s and Reproductive Health, University of Oxford. It is anticipated that the study will complete later this year.
99mTc-maraciclatide is a radio-labeled tracer which binds with high affinity to the cell adhesion protein αvβ3 integrin and images angiogenesis (new blood vessel formation) which is known to be critical to the establishment and growth of endometriotic lesions.
David Hail, Chief Executive Officer of Serac Healthcare, said:
“These promising initial findings indicate that there is real potential for maraciclatide as a novel non-invasive method of diagnosing early-stage endometriosis. The ability to visualize the early-stage of this disease is particularly significant as it cannot be seen by other imaging modalities, which contributes to the almost nine year average delay to secure a diagnosis. We are hugely encouraged by these results and look forward to continuing this work with the world-leading specialists from Oxford University.”
Endometriosis is a common disease affecting many millions of women worldwide with pain and infertility. The current delay in diagnosis results in prolonged suffering and uncertainty. Therefore, a novel imaging tool to assist healthcare professionals in identifying or ruling out the disease is urgently needed.”
Professor Christian Becker, Co-Director of the Endometriosis CaRe Centre in Oxford
Professor Krina Zondervan, Head of Department at the Nuffield Department of Women’s and Reproductive Health, University of Oxford added:
“Superficial peritoneal endometriosis is the most prevalent form of the disease. It often affects younger women for whom earlier diagnosis could enable intervention at an earlier stage, with the potential to significantly change outcomes and improve prospects. At the Endometriosis CaRe Centre at the University of Oxford our studies focus on identifying novel genetic, diagnostic and therapeutic targets for endometriosis. We are delighted about the early results of the DETECT study and are looking forward to recruiting more patients to consolidate the data.”
In a recent review article published inNutrients, researchers summarized what is known about the effects of excessive folic acid (FA) supplementation for mothers on children.
They conclude that while folate is a crucial nutrient, higher than necessary maternal FA intake may have adverse effects on their offspring.
Folate is an essential nutrient
Water-soluble vitamin B9, or folate, is needed for red blood cell (RBC) formation and to promote healthy cell growth and functioning. Doctors consider it necessary during pregnancy and lactation for fetal and placental growth, for the enlargement of the uterus, to reduce the risk of the child developing congenital disabilities in the brain and spine, and otherwise improve cardiovascular and reproductive health.
Folate can be found naturally in some foods, such as beans, peas, green leafy vegetables, and nuts. However, synthesized FA has been distributed widely in fortified food and nutrient supplements. Once consumed, it facilitates methyl group transfer among molecules, facilitating nucleotide synthesis and the metabolism of amino acids. Specifically, it is involved in methyl-donor metabolism.
Adequate FA supplementation has been associated with higher birth and placental weight and a lower risk of children being small for their gestational age and low birth weight. It also reduces the likelihood of neural tube defects (NTDs).
Continuing supplementation into the second and third trimesters has been shown to have sustained benefits for the neurocognitive development of children up to 11 years old. These included emotional intelligence, word reasoning, semantic processing, verbal-executive and motor function, attention, communication, and social competence.
Maternal deficiency of folate has been linked to numerous adverse outcomes, including elevated blood pressure and overweight in children. However, the availability of fortified foods and supplements has significantly raised folate levels in serum, RBCs, and overall, and recent studies have raised the possibility of adverse consequences of excess supplementation.
FA supplementation and ASD
Maternal intake of folate has been associated with autism spectrum disorder (ASD) incidence in addition to its neurodevelopmental benefits. A study in Norway found that FA intake starting four weeks before the pregnancy began and continuing for 12 weeks was protective against ASD.
However, a more recent study in the United States found a ‘U-shaped’ relationship between ASD risk and the frequency of maternal multivitamin supplementation. This suggests that ASD risk is highest at very low and very high levels of supplementation.
Another analysis indicates that unmetabolized folic acid (UMFA) levels in the cord blood could be positively associated with ASD risk, particularly in Black children, but further research is needed to shed light on these mechanisms.
Insights from mouse models
While well-designed mouse models can provide important information on the effects of high FA supplementation that cannot be ethically researched using human experiments, the timing and duration of supplementation, concentration of FA, how FA was administered, and the possibility of differential effects depending on the sex of the offspring must be considered.
Researchers used microarrays, Western blotting, ribonucleic acid sequencing (RNA-seq), and reverse transcription-quantitative polymerase chain reaction (RT-qPCR) to analyze the effects of FA.
Results from some studies indicate that mice exposed to an intermediate level of FA had more gene changes. In terms of sex-based differences, some genes were more affected in female mice while others were more affected in male mice, leading to differential effects in the placenta, embryonic brain, and early postnatal brain. There were also indications that FA could affect brain development early in life but lead to lasting changes in behavior into adulthood.
While maternal FA deficiency has been implicated in NTD, excess supplementation has been associated with reduced placental and embryonic weights, smaller hippocampal areas, and increased weight gain in male but not female offspring. Observed neurodevelopmental impacts included short-term memory impairment, hyperactivity-like and repetitive behavior, and increased anxiety in mouse pups.
Findings varied across studies, but there is clear evidence that excess maternal FA intake can have long-term influences on physical and behavioral outcomes. It may also be implicated in glucose metabolism and reproductive disorders, but there are no indications that there are transgenerational inheritance effects.
Conclusions
Concerns about maternal folate deficiency, but FA supplements and fortified foods are now widely available, and excess intake may have widespread effects on the central nervous system.
While there is now growing evidence of detrimental effects in addition to benefits, there is a need to translate learnings from mouse models to studies on humans and explore the sex-linked impacts. Additionally, focus should be given to new forms of FA supplementation that can mitigate the potential harms of currently available supplements.
Standing in front of the concrete steps of her home in Midway, Texas, Collier, initially barefoot and wearing a baggy gray T-shirt, told officers she planned to see a doctor in the morning because she had been bleeding.
Police body camera footage obtained by KFF Health News through an open records request shows that the officers then told Collier — who was 29 at the time and enrolled in online classes to study psychology — to turn around.
Instead of taking her to get medical care, they handcuffed and arrested her because she had outstanding warrants in a neighboring county for failing to appear in court to face misdemeanor drug charges three weeks earlier. She had missed that court date, medical records show, because she was at a hospital receiving treatment for pregnancy complications.
Despite her symptoms and being about 13 weeks pregnant, Collier spent the next day and a half in the Walker County Jail, about 80 miles north of Houston. She said her bleeding worsened there and she begged repeatedly for medical attention that she didn’t receive, according to a formal complaint she filed with the Texas Commission on Jail Standards.
“There wasn’t anything I could do,” she said, but “just lay there and be scared and not know what was going to happen.”
Welfare Check Turns Into Arrest for Pregnant Texan
Collier’s experience highlights the limited oversight and absence of federal standards for reproductive care for pregnant women in the criminal justice system. Incarcerated people have a constitutional right to health care, yet only a half-dozen states have passed laws guaranteeing access to prenatal or postpartum medical care for people in custody, according to a review of reproductive health care legislation for incarcerated people by a research group at Johns Hopkins School of Medicine. And now abortion restrictions might be putting care further out of reach.
Collier’s arrest was “shocking and disturbing” because officers “blithely” took her to jail despite her miscarriage concerns, said Wanda Bertram, a spokesperson for the Prison Policy Initiative, a nonprofit organization that studies incarceration. Bertram reviewed the body cam footage and Collier’s complaint.
“Police arrest people who are in medical emergencies all the time,” she said. “And they do that regardless of the fact that the jail is often not equipped to care for those people in the way an emergency room might be.”
After a decline during the first year of the pandemic, the number of women in U.S. jails is once again rising, hitting nearly 93,000 in June 2022, a 33% increase over 2020, according to the Department of Justice. Tens of thousands of pregnant women enter U.S. jails each year, according to estimates by Carolyn Sufrin, an associate professor of gynecology and obstetrics at Johns Hopkins School of Medicine, who researches pregnancy care in jails and prisons.
The health care needs of incarcerated women have “always been an afterthought,” said Dana Sussman, deputy executive director at Pregnancy Justice, an organization that defends women who have been charged with crimes related to their pregnancy, such as substance use. For example, about half of states don’t provide free menstrual products in jails and prisons. “And then the needs of pregnant women are an afterthought beyond that,” Sussman said.
Researchers and advocates worry that confusion over recent abortion restrictions may further complicate the situation. A nurse cited Texas’ abortion laws as one reason Collier didn’t need care, according to her statement to the standards commission.
Texas law allows treatment of miscarriage and ectopic pregnancies, a life-threatening condition in which a fertilized egg implants outside the uterus. However, different interpretations of the law can create confusion.
A nurse told Collier that “hospitals no longer did dilation and curettage,” Collier told the commission. “Since I wasn’t hemorrhaging to the point of completely soaking my pants, there wasn’t anything that could be done for me,” she said.
Collier testified that she saw a nurse only once during her stay in jail, even after she repeatedly asked jail staffers for help. The nurse checked her temperature and blood pressure and told her to put in a formal request for Tylenol. Collier said she completed her miscarriage shortly after being released.
Collier’s case is a “canary in a coal mine” for what is happening in jails; abortion restrictions are “going to have a huge ripple effect on a system already unequipped to handle obstetric emergencies,” Sufrin said.
‘There are no consequences’
Jail and prison health policies vary widely around the country and often fall far short of the American College of Obstetricians and Gynecologists’ guidelines for reproductive health care for incarcerated people. ACOG and other groups recommend that incarcerated women have access to unscheduled or emergency obstetric visits on a 24-hour basis and that on-site health care providers should be better trained to recognize pregnancy problems.
In Alabama, where women have been jailed for substance use during pregnancy, the state offers pregnancy tests in jail. But it doesn’t guarantee a minimum standard of prenatal care, such as access to extra food and medical visits, according to Johns Hopkins’ review.
Policies for pregnant women at federal facilities also don’t align with national standards for nutrition, safe housing, and access to medical care, according to a 2021 report from the Government Accountability Office.
Even when laws exist to ensure that incarcerated pregnant women have access to care, the language is often vague, leaving discretion to jail personnel.
Since 2020, Tennessee law has required that jails and prisons provide pregnant women “regular prenatal and postpartum care, as necessary.” But last August a woman gave birth in a jail cell after seeking medical attention for more than an hour, according to the Montgomery County Sheriff’s Office.
Pregnancy complications can quickly escalate into life-threatening situations, requiring more timely and specialized care than jails can often provide, said Sufrin. And when jails fail to comply with laws on the books, little oversight or enforcement may exist.
In Louisiana, many jails didn’t consistently follow laws that aimed to improve access to reproductive health care, such as providing free menstrual items, according to a May 2023 report commissioned by state lawmakers. The report also said jails weren’t transparent about whether they followed other laws, such as prohibiting the use of solitary confinement for pregnant women.
Krishnaveni Gundu, as co-founder of the Texas Jail Project, which advocates for people held in county jails, has lobbied for more than a decade to strengthen state protections for pregnant incarcerated people.
In 2019, Texas became one of the few states to require that jails’ health policies include obstetrical and gynecological care. The law requires jails to promptly transport a pregnant person in labor to a hospital, and additional regulations mandate access to medical and mental health care for miscarriages and other pregnancy complications.
But Gundu said lack of oversight and meaningful enforcement mechanisms, along with “apathy” among jail employees, have undermined regulatory protections.
“All those reforms feel futile,” said Gundu, who helped Collier prepare for her testimony. “There are no consequences.”
Before her arrest, Collier had been to the hospital twice that month experiencing pregnancy complications, including a bladder infection, her medical records show. Yet the commission found that Walker County Jail didn’t violate minimum standards. The commission did not consider the police body cam footage or Collier’s personal medical records, which support her assertions of pregnancy complications, according to investigation documents obtained by KFF Health News via an open records request.
In making its determination, the commission relied mainly on the jail’s medical records, which note that Collier asked for medical attention for a miscarriage once, in the morning on the day she was released, and refused Tylenol.
“Your complaint of no medical care is unfounded,” the commission concluded, “and no further action will be taken.”
Collier’s miscarriage had ended before she entered the jail, argued Lt. Keith DeHart, jail lieutenant for the Walker County Sheriff’s Office. “I believe there was some misunderstanding,” he said.
Brandon Wood, executive director of the commission, wouldn’t comment on Collier’s case but defends the group’s investigation as thorough. Jails “have a duty to ensure that those records are accurate and truthful,” he said. And most Texas jails are complying with heightened standards, he said.
Bertram disagrees, saying the fact that care was denied to someone who was begging for it speaks volumes. “That should tell you something about what these standards are worth,” she said.
Last year, Chiree Harley spent six weeks in a Comal County, Texas, jail shortly after discovering she was pregnant and before she could get prenatal care, she said.
I was “thinking that I was going to be well taken care of,” said Harley, 37, who also struggled with substance use.
Jail officials put her in the infirmary, Harley said, but she saw only a jail doctor and never visited an OB-GYN, even though she had previous pregnancy complications including losing multiple pregnancies at around 21 weeks. This time she had no idea how far along she was.
She said that she started leaking amniotic fluid and having contractions on Nov. 1, but that jail officials waited nearly two days to take her to a hospital. Harley said officers forced her to sign papers releasing her from jail custody while she was having contractions in the hospital. Harley delivered at 23 weeks; the baby boy died less than a day later in her arms.
The whole experience was “very scary,” Harley said. “Afterwards we were all very, very devastated.”
Comal County declined to send Harley’s medical and other records in response to an open records request. Michael Shaunessy, a partner at McGinnis Lochridge who represents Comal County, said in a statement that, “at all times, the Comal County Jail provided Chiree Harley with all appropriate and necessary medical treatment for her and her unborn child.” He did not respond to questions about whether Harley was provided specialized obstetric care.
‘I trusted those people’
In states like Idaho, Mississippi, and Louisiana that installed near-total abortion bans after the Supreme Court eliminated the constitutional right to abortion in 2022, some patients might have to wait until no fetal cardiac activity is detected before they can get care, said Kari White, the executive and scientific director of Resound Research for Reproductive Health.
White co-authored a recent study that documented 50 cases in which pregnancy care deviated from the standard because of abortion restrictions even outside of jails and prisons. Health care providers who worry about running afoul of strict laws might tell patients to go home and wait until their situations worsen.
“Obviously, it’s much trickier for people who are in jail or in prison, because they are not going to necessarily be able to leave again,” she said.
Advocates argue that boosting oversight and standards is a start, but that states need to find other ways to manage pregnant women who get caught in the justice system.
For many pregnant people, even a short stay in jail can cause lasting trauma and interrupt crucial prenatal care.
Collier remembers being in “disbelief” when she was first arrested but said she was not “distraught.”
“I figured I would be taken care of, that nothing bad was gonna happen to me,” she said. As it became clear that she wouldn’t get care, she grew distressed.
After her miscarriage, Collier saw a mental health specialist and started medication to treat depression. She hasn’t returned to her studies, she said.
“I trusted those people,” Collier said about the jail staff. “The whole experience really messed my head up.”
This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.
In a recent systematic review published in the journal Frontiers in Nutrition, researchers from Spain investigated the effect of the Mediterranean diet on the quality of semen in men of reproductive age. They found that adherence to the Mediterranean diet could improve male reproductive health by positively influencing semen quality.
Fertility research has surged as about 15% of the global population, comprising 70 million reproductive-age couples, suffer from infertility across geographies and income groups. The World Health Organization investigated infertility across 25 nations and found that male factors contributed to about half of the couples, challenging the older notion that infertility is solely a female concern. The major causes of male infertility are impaired spermatogenesis, idiopathic causes, endocrine disorders, and altered sperm motility. Clinically investigating the cause of male infertility warrants thorough history, physical examination, and semen analysis. Additionally, non-modifiable factors such as genetics and age, alongside modifiable factors such as diet and lifestyle, are also known to influence male fertility.
Popular for its potential health benefits, the Mediterranean diet demonstrates positive associations with male reproductive health, including improved semen quality attributed to its anti-inflammatory and antioxidant properties. Evidence suggests that optimal adherence to this diet may lower the risk of various chronic diseases and potentially enhance male fertility by addressing metabolic factors affecting sperm function. Therefore, researchers in the present study conducted a systematic review to understand the effect of the Mediterranean diet on the quality of semen in men of reproductive age.
About the study
Data for this review were gathered through electronic searches in PubMed, the Cochrane Library, Scopus, and Web of Science, as well as reference lists. Full-text articles were screened based on criteria evaluated independently by two authors. The quality of studies was assessed using appropriate tools such as the Crombie criteria, the Newcastle-Ottawa Scale, and the PEDro scale. Interrater reliability was evaluated using Cohen’s kappa statistic.
Inclusion criteria were open-access articles published in English or Spanish between 2012 and 2022, focusing on men aged 18 to 55. The exclusion criteria excluded unrelated articles, systematic reviews, meta-analyses, conference proceedings, and studies of specific medical conditions. A total of 10 studies met the inclusion criteria, including a total of 2,032 participants across various countries, primarily Spain. Study designs included cross-sectional, cohort, case-control, and randomized controlled trials. Data extraction focused on variables such as nutrition status, diet, and semen quality assessment techniques. After extraction, data were grouped based on assessment techniques and associations between semen quality and the Mediterranean diet.
The quality of included studies was evaluated using the Cochrane Collaboration Risk of Bias tool, evaluating domains such as randomization, intervention deviations, missing outcome data, outcome measurement, selection of reported results, and other biases, classifying each item as having a low, high, or unclear risk of bias.
Nutrition status was evaluated using weight, height, body mass index (BMI), and waist circumference, while adherence to the Mediterranean diet was assessed using validated food frequency questionnaires or specific scores. Semen quality was primarily assessed through sperm concentration, motility, morphology, volume, total antioxidant capacity, and hormone levels. Some studies also explored chromosome stability, DNA (short for deoxyribonucleic acid) fragmentation, global sperm DNA methylation, microRNA (short for micro ribonucleic acid) expression, and reactive oxygen species.
Results and discussion
Six out of 10 studies demonstrated a positive association between semen quality and following the Mediterranean diet, particularly in parameters like sperm concentration, motility, and total sperm count. In three of them, men with higher adherence levels showed significantly higher semen quality. However, two studies found no significant association between Mediterranean diet adherence and semen quality.
The present study is the first to comprehensively investigate the positive link between the Mediterranean diet and semen quality. However, the study is limited by its small sample size, observational design, and low generalizability, with evidence quality rated as very low to moderate using the GRADE (short for Grading of Recommendations, Assessment, Development, and Evaluation) system. Risk of bias assessment for randomized controlled trials indicated one trial with low risk and another with bias concerns related to intervention deviations and result evaluation. Further research with larger sample sizes and randomized controlled trials is warranted to confirm these findings.
Conclusion
In conclusion, healthy dietary habits, particularly adherence to the Mediterranean diet, are found to be associated with improved semen quality in men of reproductive age. This diet, rich in polyunsaturated fatty acids, antioxidants, and anti-inflammatory substances, may reduce oxidative stress and protect against its adverse effects on sperm. These findings highlight the importance of dietary counseling for couples planning a pregnancy or undergoing assisted reproductive technology. However, further research is necessary to explore the relationship between diet and semen quality, informing strategies for improved fertility and health outcomes.
Teenagers’ perspectives on having children are critical for improving reproductive and sex education. Due to deficiencies in reproductive health and sex education at school, they frequently underestimate their odds of conception and are unaware of age-related fertility consequences. Comprehensive reproductive health and sex education are critical for health and well-being since they reduce misconceptions and allow young individuals to make educated decisions throughout their reproductive lives.
In the United Kingdom (UK), the biology curriculum does not address vital reproductive health subjects, and knowing teenagers’ attitudes about reproduction is critical for improving the existing relationships and sex education (RSE) curriculum.
About the study
In the present study, researchers questioned secondary school students aged between 16 and 18 years about their opinions on having children.
Using the Department of Education’s database of all secondary schools in England, personal and professional relationships, and a tutor forum, the team contacted the schools and invited them to participate in the survey-based study. The 47-component online anonymous survey, which included open-ended and multiple-choice questions about demographic parameters, sex and reproduction knowledge and education, and attitudes about the potential of giving birth, was available from May 10, 2021, to July 18, 2022. The sample population consisted of 931 students.
The researchers developed questions after reviewing the RSE syllabus of England using past survey approaches. They used skip logic, guiding particular students to questions based on past responses. They conducted cognitive interviews and discussed with research professionals on the subject to determine the reliability of the questions and alternatives listed in the survey.
The team conducted one-on-one cognitive interviews with the targeted audience online, and five students (four men and one female) met the qualifying criteria. During the interview sessions, they used concurrent probing and think-aloud approaches, and all five participants piloted the study survey so that researchers could check the suitability of the survey structure, questions, and alternatives. The team modified the questions and answer choices depending on the input after each interview. They refined the questions by consulting with other reproductive health experts who had previously created comparable surveys.
The team reviewed qualitative replies multiple times to become acquainted with the content, found the initial codes, and organized them into pertinent topics. They thoroughly analyzed and named the themes. The primary researcher led the analysis, which included discussions regarding theme allocation. Some pupils provided brief remarks, but most submitted lengthy ones. They analyzed qualitative data thematically and used descriptive statistics and chi-squared tests to examine quantitative data.
Results
Among the participants, 64% wanted to be parents, and 49% planned to have two children. Students preferring not to be a parent cite the world’s unstable and unsettled state, parental anxiety, the belief that children are unnecessary, and unpleasant connections with gestation and delivery. A few female participants were concerned about the challenges and risks of pregnancy and childbirth, thinking that the procedure would permanently harm their bodies and have a negative influence on their psychological well-being afterward.
Many students (45%) were apprehensive about having children, citing fears about their capacity to have healthy children and the life their children could lead. The team identified the following six themes in their replies to the question on motherhood concerns: worries, self-doubt, health and well-being, significant investment, impediments to personal objectives, and non-inclusiveness for lesbian, gay, bisexual, and transgender (LGBTQ+) education.
Students questioned their abilities to be good parents, reflecting fear and self-doubt of being labeled as bad parents. They believed that becoming a parent would entail several financial and emotional commitments for which they were unprepared. Some students with hereditary medical issues were concerned about becoming parents since they did not want their offspring to inherit their conditions.
For several reasons, some students choose adoption over having their children. Some people stated anxiety about pregnancy and labor, and they wished to adopt it to prevent the mental and physical strains of it. Students from the LGBTQ+ category considered adoption a more feasible choice for having children than using expensive aided reproductive techniques. Students frequently dread having children by mistake because they lack awareness regarding conception rates and abortion methods. They are also concerned about their spouse leaving or filing for divorce after having children and the likelihood that their offspring would have impairments, genetic disorders, be unhealthy, or be LGBT.
Conclusion
Overall, the study findings revealed the parenting concerns of 16- to 18-year-old English school students, emphasizing the necessity for a specialized reproductive health and sex education program. Fears and uncertainties about motherhood impact their decision-making, with many female students expressing disinterest owing to pregnancy and delivery issues. Inadequate fertility education increases students’ unfavorable views regarding reproduction. The study recommends interdisciplinary training focusing on climate and biological interconnections to emphasize fertility rates and resources.
Abidemi Junaid received his B.S. in Biometrics from Zuyd University of Applied Sciences, M.S. in Biomolecular Sciences from VU University, and Ph.D. in Systems Biomedicine and Pharmacology from Leiden University. His Ph.D. work was centered around the development of high-throughput human microvessels-on-chips for studying microvascular destabilization, infectious diseases, and metabolomics.
