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In the era of Covid19 there are many global issues that demand a renewed intense focus on reproductive biology. Many of these areas are already represented by research labs at Cornell, led by a renowned group of researchers focused on Reproductive Biology. Read more about CoRe’s mission >

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Drs. Cohen and Smolka Profiled in Cornell Chronicle for Meiotic Sex Chromosome Inactivation Research Collaboration

March 2024 Drs. Paula Cohen (Professor of Genetics, Biomedical Sciences; Director, Cornell Reproductive Sciences Center; Associate Vice Provost for Research and Innovation; Associate Dean for Research, College of Veterinary Medicine) and Marcus Smolka (Professor, Molecular Biology and Genetics; Interim Director, Weill Institute of Cell and Molecular Biology) were profiled in the Cornell Chronicle last [...]

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Reproductive Health

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Reproductive Health  publishes content on all aspects of human reproduction. The journal includes topics such as adolescent health, female fertility, and family planning and contraception, and all articles are open access. Reproductive Health  has a particular interest on the impact changes in reproductive health have globally, and therefore encourages submissions from researchers based in low- and middle-income countries. 

The journal invites submissions on research in reproductive health, including social and gender issues, sexual health, country and population specific issues, assessment of service provision, education and training and also in a broader range of gynaecological and obstetrical topics related to reproductive health. 

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Cross-journal collection: Enhancing access to and uptake of contraception in low-and middle-income countries

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High uptake of menstrual health information, products and analgesics within an integrated sexual reproductive health service for young people in Zimbabwe

Authors: Mandikudza Tembo, Victoria Simms, Helen A. Weiss, Tsitsi Bandason, Nicol Redzo, Leyla Larsson, Ethel Dauya, Tafadzwa Nzanza, Pauline Ishumael, Nancy Gweshe, Rangarirai Nyamwanza, Precious Ndlovu, Sarah Bernays, Chido Dziva Chikwari, Constancia Vimbayi Mavodza, Jenny Renju…

Investigating the impact of couple counseling based on the CHARMS model on sexual quality of life and marital satisfaction of wives of men suffering from myocardial infarction: a study protocol

Authors: Soheila Rabeipoor, Kamal Khademvatani, Samira Barjasteh and Delniya Ghafuri

Implementation and evaluation of the centering pregnancy group prenatal care model in pregnant women with diabetes: a convergent parallel mixed methods study protocol

Authors: Mahsa Maghalian, Fatemeh Abbasalizadeh, Sakineh Mohammad-Alizadeh-Charandabi, Solmaz Ghanbari-Homaie and Mojgan Mirghafourvand

Incorporation, adaptation and rejection of obstetric practices during the implementation of the “Adequate Childbirth Program” in Brazilian private hospitals: a qualitative study

Authors: Débora Cecília Chaves de Oliveira, Maysa Luduvice Gomes, Andreza Rodrigues, Thamires Soares, Lucia Regina de Azevedo Nicida, Jacqueline Alves Torres and Elyne Montenegro Engstrom

Sexual health literacy level and its related factors among married medical sciences college students in an Iranian setting: a web‑based cross‑sectional study

Authors: Samaneh Nematzadeh, Zohreh Shahhosseini, Mahmood Moosazadeh and Zeinab Hamzehgardeshi

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Idiopathic isolated clitoromegaly: A report of two cases

Authors: Eray Copcu, Alper Aktas, Nazan Sivrioglu, Ozgen Copcu and Yucel Oztan

Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research

Authors: Lisa M Williamson, Alison Parkes, Daniel Wight, Mark Petticrew and Graham J Hart

The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review

Authors: Bethany Kotlar, Emily Michelle Gerson, Sophia Petrillo, Ana Langer and Henning Tiemeier

The Correction to this article has been published in Reproductive Health 2023 20 :52

Consanguinity and reproductive health among Arabs

Authors: Ghazi O Tadmouri, Pratibha Nair, Tasneem Obeid, Mahmoud T Al Ali, Najib Al Khaja and Hanan A Hamamy

What can be done to reduce the prevalence of teen pregnancy in rural Eastern Uganda?: multi-stakeholder perceptions

Authors: Josephine Nabugoomu, Gloria K. Seruwagi and Rhona Hanning

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At Springer Nature, we are committed to raising the quality of academic research across Public Health. Visit our dedicated page to view our highlighted journals and books from across our imprints, curated by our Editors.

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Collection highlight: global perspectives on reproductive coercion and abuse.

Guest Edited by Professor Laura Tarzia & Doctor Nicola Sheeran, this series focused on advancing our conceptual understanding of reproductive coercion and abuse in a global context.

Please read more about this thematic series here  and check out the accompanying blog  which summarises the research.

Collection Highlight: Understanding and supporting pregnant and parenting adolescents in sub-Saharan Africa

Guest edited by Doctor Caroline Kabiru, Doctor Anthony Ajayi and Doctor Lorretta Ntoimo, this series focused on the risks and implications of adolescent childbearing on young girls in sub-Saharan Africa. 

Please read more about this thematic series  here  and check out the accompanying  blog  which summarises the research.

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Professor Sanni Yaya is a Full Professor of Economics and Global Health, Director and the Associate Dean of the School of International Development and Global Studies at the University of Ottawa in Canada. His work focuses on a broad array of multidisciplinary topics in development and global health. He has been involved in many research projects in Africa, Europe and in North America and now works in low- and middle-income countries where he collaborates with partners to advocate for cost-effective interventions addressing Maternal, Newborn and Child Health (MNCH).  

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Reaction to the 2024 Alabama Supreme Court ruling on IVF

Read the blog by Gwendolyn P. Quinn & Laura Kimberly on the Alabama Supreme Court ruling on IVF and what it means for women with cancer.

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Read the blog by Ogochukwu Udenigwe on interpretations of motherhood and its relationship with patriarchal culture among African feminists.

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Reproductive Health

Understanding and promoting reproductive health has been a key research theme for NICHD since it was founded. Research conducted and supported by the institute continues to broaden available knowledge about the spectrum of reproductive health issues that affect all people.

NICHD continues to expand its research to improve reproductive health, including studies of the basic biology of typical and atypical reproductive system development, the mechanisms and management of gynecologic disorders and their timing, options that allow all people to manage their fertility, social and environmental influences on reproductive health, and identification of biomarkers for reproductive aging.

Visit any one of the following health topics to learn more about the institute's research efforts to related to reproductive health.

NICHD Health Topics Related to Reproductive Health

Bacterial Vaginosis

Contraception and Birth Control

Endometriosis

Fragile X-Associated Primary Ovarian Insufficiency (FXPOI)

High-Risk Pregnancy

Infertility and Fertility

Labor and Delivery

Maternal Morbidity and Mortality

Men's Reproductive Health

Menstruation and Menstrual Problems

Pelvic Floor Disorders (PFDs)

Pelvic Pain

Polycystic Ovary Syndrome (PCOS)

Pre-Pregnancy Care and Prenatal Care

Pregnancy Loss (Before 20 Weeks of Pregnancy)

Preterm Labor and Birth

Primary Ovarian Insufficiency (POI)

Puberty and Precocious Puberty

Sexually Transmitted Diseases

Urinary Tract Health

Uterine Fibroids

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Article Contents

Lay summary, current global status of male reproductive health.

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Christopher J De Jonge, Christopher L R Barratt, R John Aitken, Richard A Anderson, Peter Baker, David Y L Chan, Mark P Connolly, Michael L Eisenberg, Nicolas Garrido, Niels Jørgensen, Sarah Kimmins, Csilla Krausz, Robert I McLachlan, Craig Niederberger, Moira K ÓBryan, Allan Pacey, Lærke Priskorn, Satu Rautakallio-Hokkanen, Gamal Serour, Joris A Veltman, Donna L Vogel, Mónica H Vazquez-Levin, Current global status of male reproductive health, Human Reproduction Open , 2024;, hoae017, https://doi.org/10.1093/hropen/hoae017

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The widespread interest in male reproductive health (MRH), fueled by emerging evidence, such as the global decline in sperm counts, has intensified concerns about the status of MRH. Consequently, there is a pressing requirement for a strategic, systematic approach to identify critical questions, collect pertinent information, and utilize this data to develop evidence-based strategies. The methods for addressing these questions and the pathways towards their answers will inevitably vary based on the variations in cultural, geopolitical, and health-related contexts. To address these issues, a conjoint ESHRE and Male Reproductive Health Initiative ( M RHI) Campus workshop was convened.

The three objectives were: first, to assess the current state of MRH around the world; second, to identify some of the key gaps in knowledge; and, third, to examine how MRH stakeholders can collaboratively generate intelligent and effective paths forward.

Each expert reviewed and summarized the current literature that was subsequently used to provide a comprehensive overview of challenges related to MRH.

This narrative report is an overview of the data, opinions and arguments presented during the workshop. A number of outcomes are presented and can be summarized by the following overarching themes: MRH is a serious global issue and there is a plethora of gaps in our understanding; there is a need for widespread international collaborative networks to undertake multidisciplinary research into fundamental issues, such as lifestyle/environmental exposure studies, and high quality clincial trials; and there is an urgent requirement for effective strategies to educate young people and the general public to safeguard and improve MRH across diverse population demographics and resources.

This was a workshop where worldwide leading experts from a wide range of disciplines presented and discussed the evidence regarding challenges related to MRH. Whilst each expert summarised the current literature and placed it in context, the data in a number of areas is limited and/or sparse. Equally, important areas for consideration may have been missed. Moreover, there are clear gaps in our knowledge base, which makes some conclusions necessarily speculative and warranting of further study.

Poor MRH is a global issue that suffers from low awareness among the public, patients and heathcare professionals. Addressing this will require a coordinated multidisciplinary approach. Addressing the significant number of knowledge gaps will require policy makers prioritizing MRH and its funding.

The authors extend their gratitude to ESHRE for financial support of the Budapest Campus Workshop. PB is the Director of the not-for-profit organization Global Action on Men’s Health and receives fees and expenses for his work, (which includes the preparation of this manuscript. Conflicts of interest: CJDJ, CLRB, RAA, PB, MPC, MLE, NG, NJ, CK, AAP, MKO, SR-H, MHV-L: ESHRE Campus Workshop 2022 (Travel support—personal). CJDJ: Cambridge University Press (book royalties—personal). ESHRE Annual Meeting 2022 and Yale University Panel Meeting 2023 (Travel support—personal). CLRB: Ferring and IBSA (Lecture), RBMO editor (Honorarium to support travel etc), ExSeed and ExScentia (University of Dundee), Bill & Melinda Gates Foundation (for research on contraception). MPC: Previously received funding from pharmaceutical companies for health economic research. The funding was not in relation to this work and had no bearing on the contents of this work. No funding from other sources has been provided in relation to this work (Funding was provided to his company Global Market Access Solutions. MLE: Advisor to Ro, Doveras, Next, Hannah, Sandstone CK: European Academy of Andrology (Past president UNPAID), SK: CEO of His Turn, a male fertility Diagnostic and Therapeutic company (No payments or profits to date). RIM: www.healthymale.org.au (Australian Government funded not for profit in men’s health sector (Employed as Medical Director 0.2 FET), Monash IVF Pty Ltd (Equity holder). NJ: Merck (consulting fees), Gedeon Richter (honoraria). SR-H: ESHRE (Travel reimbursements). CN: LLC (Nursing educator); COMMIT (Core Outcomes Measures for Infertility Trials) Advisor, meeting attendee and co‐author; COMMA (Core Outcomes in Menopause) Meeting attendee and co‐author; International Federation of Gynecology and Obstetrics (FIGO) Delegate Letters and Sciences; ReproNovo, Advisory board; American Board of Urology Examiner; American Urological Association Journal subsection editor, committee member, guidelines co‐author Ferring Scientific trial NexHand Chief Technology Officer, stock ownership Posterity Health Board member, stock ownership. AP: Economic and Social Research Council (A collaborator on research grant number ES/W001381/1). Member of an advisory committee for Merck Serono (November 2022), Member of an advisory board for Exceed Health, Speaker fees for educational events organized by Mealis Group; Chairman of the Cryos External Scientific Advisory Committee: All fees associated with this are paid to his former employer The University of Sheffield. Trustee of the Progress Educational Trust (Unpaid). MKO’B: National Health and Medical Research Council and Australian Research Council (Funding for research of the topic of male fertility), Bill and Melinda Gates Foundation (Funding aimed at the development of male gamete-based contraception), Medical Research Future Fund (Funding aimed at defining the long-term consequences of male infertility). MHV-L: Department of Sexual and Reproductive Health and Research (SRH)/Human Reproduction Programme (HRP) Research Project Panel RP2/WHO Review Member; MRHI (Core Group Member), COMMIT (member) EGOI (Member); Human Reproduction (Editor), Fertility and Sterility (Editor), AndroLATAM (Founder and Coordinator).

WHAT DOES THIS MEAN FOR PATIENTS?

There is a growing interest in men's reproductive health because of new evidence showing a decline in sperm counts worldwide. Researchers have found links between poor reproductive health in men and other health problems. They are also looking into how a father's health can affect their children's well-being. To tackle these issues, the European Society for Human Reproduction and Embryology and the Male Reproductive Health Initiative organized an international workshop. The goals were to assess the current state of men's reproductive health globally, pinpoint knowledge gaps, and come up with plans for the future. This report summarizes the information, opinions, and discussions from the workshop. The main takeaways are that men's reproductive health is a serious global concern and there is a lot we still do not understand. The report emphasizes the need for international collaborations to study important issues like the impact of lifestyle and environmental factors. It also highlights the urgency of finding effective ways to reinforce education about how to protect and improve men's reproductive health across different demographics (for example age, race) and resources. To complement this analysis, we have recently published a practical plan, based on the evidence, to guide us in moving forward. This plan emphasizes the importance of everyone around the world working together to make men's reproductive health a top priority.

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The Sexual and Reproductive Health of Adolescents and Young Adults During the COVID ‐19 Pandemic

Laura d. lindberg.

1 Guttmacher Institute, New York

David L. Bell

2 Department of Pediatrics and Department of Population and Family Health, Columbia University Medical Center, New York

Leslie M. Kantor

3 Department of Urban—Global Public Health, Rutgers School of Public Health, Rutgers University, New Yark NJ

The COVID‐19 public health crisis is having rapid and profound effects on how people around the world are living their lives. Adolescents and young adults (AYA) aged 12–24 in the United States are at low risk for hospitalization and death from COVID‐19 compared with other age‐groups. * However, the disease may affect other aspects of their physical, mental and social health. Sexual and reproductive health (SRH) touches upon all of these domains, and involves intimate relationships, sexual activity, contraceptive use and abortion care. Evidence of the SRH impacts of previous large‐scale disruptions in the United States, including natural disasters 1 and the 2008 recession, 2 suggests that the current pandemic will have serious and sustained effects on young people. AYA will experience the current pandemic in ways that reflect their unique developmental and cohort situations. 3 In this viewpoint, we review potential immediate and longer term impacts of the COVID‐19 pandemic on the SRH needs and behaviors of AYA, and provide direct evidence of COVID‐19 impacts where available.

Impact on Sexual and Reproductive Health

Adolescents’ and young adults’ sexual and reproductive health is being and will continue to be impacted by the COVID‐19 pandemic through both distal and proximal pathways (Figure  1 ). The pandemic has brought about dramatic social and economic changes, including social distancing, a period of stay‐at‐home requirements, nearly universal school closures, increased engagement with parents or other household members, and growing economic insecurity. Among older AYA, college closings, financial issues and the desire to be with family have brought some back into their parents’ household after a period of having gained some independence. These widespread social and economic shifts have disrupted AYA romantic and sexual relationships, as well as their access to affordable and confidential health care services and resources. We explore how these social, economic and proximal influences may affect AYA intimate and sexual behaviors and the use of a range of SRH services.

Pathways of COVID‐19–related influence on the sexual and reproductive health of adolescents and young adults

Relationships and sex

The COVID‐19 pandemic has interrupted many of the normative aspects of AYA development, a period that should be marked by growing independence 3 and strengthening peer relationships. 4 Many young people currently face increased parental monitoring and reduced privacy. This increased monitoring, diminished independence and reduced physical interaction with peers will likely have yet unknown effects on this cohort's developmental trajectory, † especially since we don't know how prolonged or widespread the disruptions will be, and whether they will recur.

For most young people, social distancing and stay‐at‐home guidelines have likely resulted in less partnered sex. However, during the pandemic's initial peak, about one‐third of 13–17‐year‐olds in a national survey reported that they were still meeting close friends in person. ‡ , 5 Some AYA will continue to engage in partnered sexual behaviors, either in established relationships (including cohabiting ones) or with new partners. Online social connections are also important. Today's youth are digital natives who are frequently online for entertainment, learning and socializing, and these digital interactions offer options to connect despite the social disruptions inherent in physical distancing and stay‐at‐home orders. 4 In fact, as a result of social distancing during the pandemic, 65% of teenagers were texting with friends and family, or interacting with them via social media, more often than usual. 5 These forms of digital communication also offer a means for romantic or sexual interactions, including conversations, online dating, sexting, virtual sex and other online activities. 6

For AYA in established or new relationships, physical separation may influence relationship quality or stability. For some, physical distancing from partners results in less sexual or physical intimate partner violence (IPV). § For individuals who cohabit with a partner, however, stay‐at‐home orders may increase the risk of experiencing IPV. Online emotional abuse by a partner may also occur for those who are currently physically separated. Disruptions such as school or workplace closures and reduced access to health care may exacerbate these issues and make it harder for young people to seek support or interventions. 7

Access to and use of SRH care

The pandemic has imposed economic and logistical barriers to obtaining contraceptive and other SRH services for all ages, but has particular implications for AYA. Loss of their own or parents’ earnings or health insurance creates economic barriers to accessing care and paying for contraceptive methods. Beyond cost issues, the ability to obtain SRH care that is confidential and private is hampered for young people sheltering in place with parents or guardians and may influence their behaviors. Research has found that AYA who have concerns about confidentiality are less likely to use SRH services and report lower levels of contraceptive use. 8 , 9 Pandemic‐driven changes in how services are provided, such as limiting in‐person care and deferring new and walk‐in patients, also create barriers. In addition, individuals may want to avoid obtaining in‐person care during this time to reduce the risk of viral transmission. Recently, a group of clinicians offered guidelines and practice protocols for providing contraceptives to young people as an essential service despite COVID‐19 disruptions, as well as strategies for maximizing access and confidentiality. 10

Increasing use of telemedicine approaches (by either video or phone) and online contraceptive provision may ultimately expand access to SRH care for AYA. But for now, many issues make telemedicine particularly challenging for this age‐group. 11 , 12 Although medical guidelines strongly endorse patient privacy, such privacy may be difficult to obtain during a young person's telemedicine visit. 13 Young people at home with family may not have a private place where they won't be overheard. Further, many commercial telemedicine services do not accept insurance or offer sliding‐fee scales. 14 Telemedicine visits generally require that prescriptions be submitted to a pharmacy, which means AYA who are uninsured must pay the retail cost of these medications, rather than the low out‐of‐pocket costs they would pay in many SRH clinics. Moreover, the “digital divide” that exists in the United States means that individuals who live in certain areas or have low socioeconomic status may not have adequate access to online health care. 15

The pandemic has increased barriers to SRH care for already underserved youth, including LGBTQ young people, unhoused individuals, and those in the foster care system, the criminal justice system and immigrant detention centers. Although telemedicine may be an option for some, these groups are less likely than others to have an established relationship with a health care provider and may find the cost of services prohibitive. Furthermore, providers who are available through telemedicine may not offer inclusive or culturally aware care, or be able to provide needed specialized services; for example, access to gender‐affirming hormone therapy may still require in‐person visits, and providers report delaying new visits for such care. 16 The pandemic may also increase the need for SRH care for the most vulnerable youth if trading sex for money or food becomes a more common survival strategy. 17

Preventive and screening services

The COVID‐19 pandemic is also impacting young people's use of SRH preventive and screening services. Analysis of pediatric electronic health records found that HPV vaccinations declined by 68% from February to early April of 2020; this decline was greater than that observed for other pediatric vaccines (e.g., measles, mumps and rubella shots dropped by 50%). 18 Similarly, the Centers for Disease Control's tracking of vaccine‐ordering statistics through late April found less of a decline in vaccinations for children younger than two than for those two or older, 19 and vaccination data for New York City echo this. 20 Together, these data suggest that adolescents are more likely than younger children to miss well‐visits or receive incomplete ones.

Although STI testing and treatment are critical for health, access for young people is likely diminished in the absence of regular well‐visits. 14 Routine screening for STIs may not occur, despite medical guidance for universal chlamydia screening of sexually active females younger than 25. 21 STIs are often asymptomatic, so missed screenings will result in untreated infections, which may have serious negative sequelae. Telemedicine treatment for patients and their sex partners can minimize in‐person health care contacts. Although young people's STI rates may decline because of reduced physical access to sexual partners, delays in getting screened and treated, or the inability to do so, will make the situation worse for those infected.

Abortion care

The logistical and economic challenges to obtaining needed SRH care as a result of the COVID‐19 pandemic are even more significant regarding young people's ability to obtain abortions. As of May 19, 2020, at least 11 states had exploited the pandemic to ban or restrict access to abortion, ostensibly on the grounds that abortion provision is “nonessential health care”; 22 these declarations contradict the statements of leading medical experts asserting that abortion remains an essential and time‐sensitive health service during the COVID‐19 crisis. 23 Moreover, the abortion bans increase patients’ costs and travel distances, which may cause AYA to delay obtaining an abortion or make such care completely inaccessible. 24 For young people living in states with COVID‐19–related abortion bans, the option of traveling out of state may not be as feasible as it is for older women, owing to lack of transportation or financial resources, and lack of autonomy and privacy. Evidence from earlier state efforts to limit minors’ access to abortion showed that the distance to providers is a significant barrier. 25 For minors who need an alternative to meeting parental permission requirements, the process of obtaining a judicial bypass has become even more complicated and burdensome during the pandemic. Although most adolescents who decide to terminate their pregnancy involve a parent, 26 others fear that their parents will react with violence or kick them out of their home. 27 The current crisis may also shift AYA pregnancy desires away from intending or wanting to have a child. Data collected online in early May found that nearly four in 10 female respondents aged 18–24 reported that because of the pandemic they now want to have a baby later than they had previously planned. 28

Sex education

Sex education is critical to AYA sexual and reproductive health and is associated with positive health outcomes. 29 , 30 Before the pandemic, schools were a key source of formal sex education for young people. 31 Sex education, which was already limited in many areas of the country, 32 , 33 has likely not been included in the national shift to online learning. Even when in‐person schooling resumes, missed sex education instruction is unlikely to be made up, given the modest attention it received prior to the pandemic. Exacerbating this missed instruction, funding for sex education may be cut as a result of the economic downturn, and hence schools may reduce its provision even more. AYA often go online to find SRH information, and such resources will become more critical for youth who are unable to obtain information from schools or health care providers. Yet young people may receive inaccurate information when they search for answers online, and specific information may be unavailable. 34 For example, guidelines for making sex safer during the pandemic that were released by the New York City Department of Health and Mental Hygiene were removed from their website at one point because of controversy (the guidelines were later reinstated when that action became public). 35 The risk of contracting COVID‐19 from sexual transmission is still unknown, but the virus has been identified in semen. 36

Future Shifts in Behavior and Health Care

Although the impacts of the pandemic are still unfolding, there are potential longer term consequences that will shape AYA sexual and reproductive health. These may include shifts in individual SRH behaviors and outcomes, and in the health care services and systems that serve young people. All of these elements will influence future SRH trends.

First, behavioral shifts among adolescents and young adults may continue. As social isolation and physical distancing practices diminish, there may be a period of “making up for lost time” in which sexual activity increases; this may be particularly true in the upcoming summer months when schools are closed and conventional summer activities are hampered. Also, psychological fatigue from following behavioral restrictions because of COVID‐19 could lead to AYA having more unprotected sex, especially if restrictions persist over the long term. 37 Young people's ability to leave abusive relationships will likely be constrained by financial factors, including high levels of sustained unemployment.

Second, some of the potential adverse health outcomes of the COVID‐19 crisis may be mitigated if in the months following the end of stay‐at‐home orders there is a period of health care catch‐up and individuals seek out delayed care, including well‐visits, contraceptive care and HPV vaccinations. The demonstrated decline in vaccination uptake may eventually be made up, but it is unclear how long it will take to get those rates back to their previous levels, and this could lead to higher rates of cervical cancer for this cohort. One positive outcome of the epidemic could be that the appetite for a COVID‐19 vaccine may shift the public's perceptions of vaccines in a positive direction and ultimately increase HPV vaccine acceptance.

A third pandemic‐driven shift involves telemedicine. If this remains an option for SRH services moving forward, we expect AYA to be the age‐group most likely to continue that approach rather than returning to traditional in‐person visits. Innovations in health care service provision, such as use of telemedicine and obtaining contraceptives and STI testing by mail, will help expand access to SRH care for young people. However, use of these innovative approaches to care may increase access differentially (e.g., between the insured and the uninsured) and heighten service gaps for particularly marginalized young people, such as homeless youth, youth living in or transitioning out of foster care, incarcerated youth and immigrants in detention. Shifts in contraceptive method mix will be another important area to evaluate over the coming years, as anticipation of future waves of coronavirus infection could further the trend toward use of long‐acting reversible methods. Ongoing and future research is needed to follow this cohort's individual experiences and interactions with the SRH care system.

Another development that may occur encompasses SRH services more broadly. The SRH field has often been innovative in advancing service provision and reducing onerous medical requirements. For example, same‐day start of contraception, elimination of pelvic exams for obtaining birth control and telemedicine‐directed medication abortion are examples of expanding access to and availability of care. Greater use of telemedicine for AYA care and providing many contraceptive methods by mail could go a long way to improving overall access to SRH services. However, such mode of delivery changes will not be enough to compensate for the inability to pay for care because of young people's loss of parents’ or their own employer‐provided insurance.

Finally, many reproductive health care providers and SRH facilities that are part of larger systems may go out of business as a result of the pandemic‐driven reductions in patient volume. In addition, demands on state budgets may cause further closures and restrict access to needed services for years to come. Economic public policies for health care during the COVID‐19 crisis have focused primarily on supporting hospitals rather than the freestanding health centers and individual practices at which most SRH care is provided. The publicly funded clinic network, especially the segment funded by Title X, has always served the most marginalized AYA, including those who are low‐income or without insurance, or who need the confidentiality protections assured through Title X mandates. In the 2010–2015 period, more than one‐fourth of AYA women who received contraceptive care went to a publicly funded clinic. 38 Service demand at these clinics may increase as young people's loss of private insurance makes care at private providers unaffordable. However, Title X–funded clinics are not well positioned fiscally to meet such increased demand, especially given that the network's service capacity has been slashed nearly in half by the imposition of the domestic “gag rule”—and its restrictive regulations that prohibit referrals for abortion care—that led clinics to leave the program. 39

Policy Recommendations

The COVID‐19 pandemic has highlighted a number of critical policy opportunities that can improve SRH care and services for adolescents and young adults. Proposed policies focus on the need to approach SRH care, including contraceptive services, as essential health care for all people regardless of age. 40 , 41 Future policies must also remain responsive to the unique and changing needs of AYA. To support and strengthen young people's sexual and reproductive health, new policies should:

•Prioritize the provision of confidential care for AYA and ensure privacy for their insurance and medical records.

•Eliminate restrictions on any SRH service that can be provided via telemedicine, including those on telemedicine medication abortion, and support providers in expanding digital access.

•Ensure continued coverage of birth control methods and counseling, HPV vaccinations and other SRH preventive services through the Affordable Care Act and within public and private health care plans.

•Create effective programs to assist AYA and their families to sign up for the Child Health Insurance Program (CHIP), Medicaid or other insurance coverage for those who are newly uninsured or experiencing reduced income because of COVID‐19–induced economic changes.

•Increase funding for the Title X national family planning program to address the likely growing numbers of uninsured individuals and increased demand for publicly funded SRH services among AYA.

•Reduce barriers to meeting AYA health care needs by removing inappropriate restrictions that ban Title X–funded providers from sharing information about abortion and by assuring that young people's care is confidential.

•Develop and disseminate online sex education curricula, and ensure the availability of both in‐person and online instruction in response to school closures caused by the pandemic.

•Fund ongoing surveillance of young people's SRH in light of the widespread COVID‐19 disruptions, including methodologies that allow for robust analyses of vulnerable subpopulations such as young people of color and LGBTQ individuals.

Efforts to support adolescents and young adults must also attend to broader impacts on their sexual and reproductive lives, including their ability to form and maintain romantic relationships and experience their sexuality in positive ways. How they navigate their transitions to adulthood—including decisions about education, work, union formation and fertility—may be affected by the pandemic and its economic and societal consequences. Even when social distancing is no longer as necessary, the COVID‐19 pandemic will have caused and may continue to create far‐reaching social disruptions in young people's lives, which may continue to affect their health. During the current public health crisis, the sexual and reproductive health of adolescents and young adults must not be overlooked, as it is integral to both their and the larger society's well‐being.

Laura D. Lindberg is principal research scientist, Guttmacher Institute, New York. David L. Bell is associate professor, Department of Pediatrics and Department of Population and Family Health, Columbia University Medical Center, New York. Leslie M. Kantor is professor and chair, Department of Urban–Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, NJ.

* There is growing concern about COVID‐19 health impacts that have been seen in small numbers of children and adolescents.

† The adolescent developmental trajectory includes physical, cognitive, emotional and social changes that are typically defined as beginning at puberty and ending with the attainment of adult roles and responsibilities.

‡ This survey was conducted by Common Sense Media between March 24 and April 1, 2020, and collected data from 849 individuals aged 13 – 17; data were weighted for age and sex using the U.S. Census Bureau's American Community Survey to reflect the demographic composition of this age‐group.

§ Before the pandemic, 8% of high school students reported having experienced physical dating violence, and 7% sexual dating violence, in the last year.

Women’s Reproductive Health

Contraception (birth control).

• Heart Defects and Women's Reproductive Health
• Hysterectomy

Female Genital Mutilation/Cutting

Infertility.

A woman’s reproductive system external icon is a delicate and complex system in the body. It is important to take steps to protect it from infections and injury, and prevent problems—including some long-term health problems. Taking care of yourself and making healthy choices can help protect you and your loved ones. Protecting your reproductive system also means having control of your health, if and when, you become pregnant.

Women’s health and women’s reproductive health are high priorities for CDC’s Division of Reproductive Health. Our goal is to improve women’s health from menarche through menopause. CDC/DRH activities focus primarily on research about the following:

There are several safe and highly effective methods of birth control available to prevent unintended pregnancy. These include intrauterine contraception, hormonal and barrier methods, and permanent birth control (sterilization). Using effective birth control methods can greatly reduce the chances of having an unintended pregnancy. CDC’s Division of Reproductive Health has a long history of conducting epidemiologic studies on the safety and effectiveness of contraceptive methods. Results from these studies have informed contraceptive practices.

We monitor prevalence and treatment of depression among women of reproductive age and postpartum depression. Depression is common. Often, trying to get pregnant, being pregnant, or the birth of a baby can increase the risk for depression. Also, many women don’t know that depression sometimes happens with other events, such as losing a baby or having trouble getting pregnant. Women may also feel depressed for many other reasons—some may not even know why. There are ways to help you feel better, such as counseling or other treatments. Talking to your health care provider is a good first step if you think you may suffer from depression.

Heart Defects and Women’s Reproductive Health

Get informed about contraception, preconception health, and pregnancy for people living with heart defects. If you’re living with a heart defect, you may need specialized medical care to manage your reproductive health and heart health.

Hysterectomy external icon

Hysterectomy is the surgical removal of a woman’s uterus. The uterus is the place where a baby grows when a woman is pregnant. Sometimes the cervix, ovaries, and fallopian tubes are also removed. Hysterectomies are very common—1 of 3 women in the United States has had one by age 60.

Female genital mutilation or cutting (FGM/C) is defined by the World Health Organization (WHO) as “all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons.” These procedures could mean piercing, cutting, removing, or sewing closed all or part of a girl’s or woman’s external genitals.

Infertility means not being able to get pregnant after 1 year of trying. If a woman is 35 or older, infertility is based on 6 months of trying to become pregnant. Women who can get pregnant but are unable to stay pregnant may also be considered infertile. About 10% of women (6.1 million) in the United States aged 15–44 years have difficulty getting pregnant or staying pregnant. CDC is committed to preventing infertility and its burden on women and families. We work with other federal agencies and nonprofit organizations providing data and evidence about infertility, including its causes and consequences.

Menopause external icon external icon

Menopause is a normal change in a woman’s life when her period stops. A woman has reached menopause when she has not had a period for 12 months in a row. This often happens between 45–55 years of age. Menopause happens because the woman’s ovary stops producing the hormones estrogen and progesterone.

Read more about some other common reproductive health concerns for women.

Find a Health Center external icon Health Resources Services Administration (HRSA) health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income.

Womenshealth.gov:  A—Z Health Topics external icon

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• Adolescent Sexual and Reproductive Health

Gender Based Violence

Gender disparities, maternal health.

• Men’s Sexual and Reproductive Health
• Pregnancy prevention: Family Planning/Unintended pregnancy and Abortion

Adolescent Sexual and Reproductive Health

Clinical correlates of mycoplasma genitalium in young women.

Maria Trent The primary aims of this study are to determine the rate and 12-month longitudinal clinical correlates of MG and TV infection among a sample of young pregnant women 13-29 years of age seeking reproductive health care in an urban hospital setting. The outcomes of this work will be critical for determining need for integration of MG testing in routine laboratory testing once available.

Evaluation of Sexual Health Curriculum for Health Students in Tanzania

Maria Trent As documented in the US Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior, training of health providers in sexual health care is critical to addressing a broad array of the nation's sexual and reproductive health concerns. Yet rigorous trials evaluating the effects of sexual health curricula on provider behavior are rare. In sub-Saharan Africa, an environment which has the highest rates of HIV, STI, teen pregnancy, unwanted pregnancy, unsafe abortion, child marriage of girls and sexual assault of boys in the world, and where female genital cutting, wife-beating, marital rape, criminalization of homosexuality, stigmatization of Lesbian, Gay, Bisexual and Transgender (LGBT) persons, myths about masturbation leading to dysfunction, and rates of sexual dysfunction in both men and women are common, we could find no formalized training of health providers in sexual health care. Sexual health education, even of health providers, is a sensitive issue in Africa. Consequently, a rigorous study of its effects is needed, if such education is to be widely adopted. Recently, at Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, we adapted a PAHO/WHO sexual health curriculum training for healthcare providers for implementation in Tanzania. Participants were 87 nursing, midwifery, and allied health science students. Pre-post evaluations show the curriculum to be highly acceptable, needed, and desired by students, feasible in implementation, and effective in improving student knowledge, attitudes, and skills in providing sexual health care to patients. The logical next step in this line of research is to conduct the first rigorous trial of a comprehensive sexual health training curriculum for health professionals in Tanzania. There are three specific aims. Aim 1 is to conduct a social ecological needs assessment of sexual health care delivery in Tanzania. To determine whether midwifery, nursing, medical, and allied health science students would benefit from one curriculum or separate curricula tailored by discipline, we will conduct focus groups (3 from each discipline). We will also conduct individual interviews with key informants to address structural and cultural issues. In Aim 2, we will further adapt our curriculum, ensure it is culturally tailored to the Tanzanian/sub-Saharan context, and pilot test it. Aim 3 is to evaluate the effectiveness of an African-based, culturally-appropriate, sexual health curriculum. We will conduct a randomized, controlled, single blinded trial of the curriculum against a waitlist control assessing effects on sexual health knowledge, attitudes, and counseling skills (n=206 students per arm; 412 in total). Hypotheses will test if the curriculum is effective, and whether it is more effective for one discipline than another. If effective, MUHAS has committed to implement the curriculum for all their health students. Given MUHAS is preeminent in health student education across Africa, the curriculum assessed in this study has high potential to be widely adopted as a new standard of training for health professionals across Africa.

Faith-based Adolescents Involved in Total Health

Terrinieka Williams Powell Focused on those areas of Baltimore where the adolescent pregnancy rates are the highest, this study aims to understand what is currently being done in the churches of those communities to address pregnancy prevention and to identify the potentials and barriers for effective interventions.

The Global Early Adolescent Study

Robert Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson The Global Early Adolescent Study (GEAS) seeks to understand how norms, attitudes and expectations about gender influence health outcomes and behaviors across the adolescent period. Building upon formative, mixed-methods research conducted in sixteen countries between 2014 and 2016, the GEAS has collected baseline data from over 13,000 adolescents on five continents since 2017. Additional survey topics include sexual and reproductive health, mental health, body comfort, school retention and empowerment. In four countries, the GEAS is used to evaluate the longitudinal impact of gender-transformative interventions carried out by Rutgers, Netherlands; Save the Children and the Institute of Women and Ethnic Studies. Participating GEAS sites include New Orleans, USA; Cuenca, Ecuador; Santiago, Chile; São Paolo, Brazil; Belgium; Indonesia; Shanghai, China; Kinshasa, DRC; Cape Town, South Africa; and Blantyre, Malawi. Results from the longitudinal GEAS will help to answer important questions about the formation and manifestations of gender inequality, its relationship to health and well-being and the interventions that are effective in promoting gender equality.

Current activities include efforts to improve awareness of and response to ethical issues in research and programming with adolescents living in vulnerable contexts the development of a special supplement using baseline GEAS focused on gender equality. At present, students are involved in manuscript development with partners in China, Ecuador, Bolivia and Malawi. For more information about the GEAS, including our global network of collaborators, recent reports and publications and open-access survey and training instruments, please visit the GEAS website.

Harriet Lane Clinic’s Title X Program

Arik V. Marcell Funded by the Office of Population Affairs, to provide reproductive health services to adolescents & young adults who are uninsured, underinsured or seeking confidential services and conduct quality improvement strategies to ensure providers are delivering quality family planning and sexual and reproductive health care services.

Technology Enchanced Community Health Nursing to Reduce Recurrent STIs after PID

Maria Trent This study examines the efficacy of a technology-enhanced community health nursing intervention on adherence to PID treatment recommendations and subsequent short-term sexually transmitted infection acquisition using a randomized controlled trial.

Community-partnered technology for partner violence prevention and response: MyPlanKenya

Michele Decker, Nancy Glass (School of Nursing) This initiative adapts and refines a safety planning “app” intervention for women in urban Kenya, followed by evaluation via randomized controlled trial. The app enables priority-setting for safety-related decisions and provides support and referrals to local resources. It harnesses community health volunteers (CHVs) as key lay professionals poised to play a critical role in partner violence prevention and response. With support from ideas42.

Continuum of Shelter and Housing Models for Victims of Intimate Partner Violence

Michele Decker, Charvonne Holliday With support from the National Institute of Justice, this initiative entails formative evaluation and evaluability assessment for leading models of housing stabilization for partner violence survivors, specifically rapid rehousing and transitional housing, in partnership with House of Ruth Maryland. Following a formative phase, we monitor health, safety, and well-being indicators among IPV survivors receiving housing support over a 6-month follow-up period, and evaluate readiness to support IPV survivors among housing providers.

Developing and Piloting A Gender-Based Violence Intervention Module to Reduce HIV Risk among Female Sex Workers (FSWs)

Michele Decker, Susan Sherman (Epi), Nancy Glass (School of Nursing) With support from the Johns Hopkins Center for AIDS Research (P30AI094189, PI Chaisson), this initiative uses a community-based participatory approach to develop and pilot test a brief violence intervention module to encourage violence-related harm reduction, provide social support related to violence victimization, and reduce related HIV risk behavior among women who trade sex or are sexually exploited.

Collaborative for Gender Equity and Empowerment in Education, Health and Labor Systems

Michele Decker, Lori Heise, Nancy Glass, Rosemary Morgan, Colleen Stuart, Toni Ungaretti, Vivian Lee This collaborative blends gender analysis with case studies and development and field testing of new indicators for gendered aspects of labor, education and health systems, in collaboration with academic and community partners.

Duration of Hormonal Contraceptive Use: Immune Responses & Vaginal Microbiota

PI: Dr. Khalil Ghanem – Co-investigator: Anne Burke This NIH-funded study investigates the impact of hormonal contraceptives on the vaginal microbiome. Use of postpartum IUDs and implants. This study evaluates outcomes in women who receive long-acting contraception in the immediate postpartum period.

Gender barriers to non-communicable disease prevention, treatment and management

Michele Decker, Rosemary Morgan, Nancy Glass This collaboration with World Health Organization applies gender analysis frameworks to non-communicable diseases via a scoping review of gender barriers to care, primarily in low and middle income countries.

Bob Blum, Caroline Moreau, Kristin Mmari, Saifuddin Ahmed, Lori Heise, Leah Keonig, Mengmeng Li, Mark Emerson The purpose of The Global Early Adolescent Study is to understand how gender norms influence sexual attitudes and relationship formation in early adolescence as well as subsequent sexual activity and contraceptive practices in older adolescence. Specifically, the study explores: 1) gender socialization in early adolescents; 2) how gender norms inform sexual and reproductive health (SRH) across adolescent years 3) how gender transformative interventions can improve SRH trajectories. The study takes place in 9 urban poor sites across 4 continents (South Africa, Malawi, DRC, Belgium, China, Indonesia, Chili, Brazil and the United States) and follows between 600 and 3000 young adolescents 10-14 years in each site over a 3 to 5 year period. This research provides empirical evidence testing gender pathways to SRH while guiding programs to overcome gender discrimination and promote women’s and girls’ wellbeing. To learn more please visit the GEAS page .

Antihypertensive Medication in Pregnancy: An Update from the 2011 WHO Recommendations for Prevention and Treatment of Preeclampsia and Eclampsia

Donna Strobino, Saifuddin Ahmed, Erika Werner (Brown Univ, school of Medicine), Mahua Mandal, Laina Gagliardi, and Roxanne Beltran The aim of this project is to update the science behind WHO recommended anti-hypertensive medications in pregnancy to prevent preeclampsia and manage hypertension and to estimates the prevalence of chronic hypertension, preeclampsia and all hypertensive disorders in pregnancy using data from population- based studies worldwide and facility based studies in resource poor settings. The study also using extant data to estimate unmet need and potential demand for antihypertensive medications in pregnancy in low resource settings.

Contraceptive Efficacy of a Novel Vaginal Ring

Anne Burke This is an upcoming NICHD-funded, prospective study evaluating use of a vaginal contraceptive ring in healthy women. Pharmacokinetics of oral contraceptives before and after bariatric surgery. This study compares pharmacokinetic and pharmacodynamic profiles of oral contraceptive use for women undergoing gastric bypass surgery.

Men's Sexual and Reproductive Health

Project connect baltimore.

Arik V. Marcell This is a CDC-funded program to evaluate school and community-based methods to engage males in HIV/STD testing and sexual and reproductive health care in Baltimore City by training youth-serving professionals on a web-based clinical services provider guide for male-specific clinical services (Y2CONNECT.org). If successful, this project will advance the field of male health promotion through its use of innovative approaches and technology that are easily transferable to a variety of settings and implemented at low cost

Technology Enchanced Community Health Nursing Study

Maria Trent The study involves 350 young women 13-21years old diagnosed with PID in Baltimore and randomize them to receive CHN clinical support using a single post-PID face-to-face clinical evaluation and SMS communication support. We hypothesize that repackaging the recommended CDC-follow-up visit using a technology-enhanced community health nursing intervention (TECH-N) with integration of an evidence-based STI prevention curriculum will reduce rates of short-term repeat infection by improving adherence to PID treatment and reducing unprotected intercourse and be more cost-effective compared with outpatient standard of care (and hospitalization). To learn more, please visit the Study Record Detail page .

Pregnancy Prevention: Family Planning/Unintended Pregnancy and Abortion

Advance family planning.

Duff Gillespie, Beth Fredrick Advance Family Planning (AFP) is an advocacy initiative established in 2009 at the William H. Gates Sr. Institute for Population and Reproductive Health. AFP aims to increase the financial investment and political commitment needed to ensure access to high-quality, voluntary family planning through collaborative, evidence-based advocacy aimed at working effectively with decision-makers. AFP is supported by the Bill & Melinda Gates Foundation, the David & Lucile Packard Foundation, and the William and Flora Hewlett Foundation.

Evidence of COVID-19’s Potential Impact on Inequities in Abortion Access

Suzanne Bell, Anne Burke,  Carolyn Sufrin

Results from a small study completed by Bloomberg School faculty and students found that COVID-19 potentially increased existing inequities related to abortion. The study looked at abortion service availability and care seeking experiences in the Washington, DC, Maryland, and Virginia region during the pandemic and found that financially disadvantaged groups were disproportionately negatively impacted.  More information is found in the facsheet,  

FP quality metrics in Maryland

Caroline Moreau, Anne Burke This project aims to test a framework for monitoring quality of care for family planning among all women of reproductive age in Maryland, using computerized data found in health insurance claims and electronic health record (EHR) systems

Measuring the incidence and safety of Abortion

Caroline Moreau, Suzanne Bell The PMA Abortion project aims to use the PMA platform to conduct research on Abortion in 3 geographies (Cote D’Ivoire, Nigeria, Rajasthan) to assess abortion prevalence and safety using both direct and indirect measures and to explore women’s access to care for abortion procedures.

PMA Agile: Monitoring family planning service delivery and use at the subnational level

Amy Tsui, Scott Radloff, Phil Anglewicz This project is being implemented in 13 urban sites in collaboration with research partners in Burkina Faso, DR Congo, India, Kenya, Niger and Nigeria. PMA Agile conducts quarterly surveys of health facilities and semi-annual surveys of clients to monitor change in service preparedness and quality as well as client satisfaction and their continued use of contraception.

Performance Monitoring in Action

Scott Radloff Performance Monitoring for Action or PMA for short (formerly PMA2020) is a Bill and Melinda Gates Foundation funded project, implemented in partnership with Jhpiego and a network of university and research institutions, that supports rapid-turnaround surveys to monitor progress in reproductive health indicators. The project was launched in 2013.

PMA implements cross-sectional and longitudinal surveys to fill a data gap – collecting information to understand the drivers of contraceptive use dynamics – information that is not currently measured by other large-scale surveys. While having a core family planning focus, the PMA platform can be used for data collection in other health topics. To date the platform has been used to collect data for guiding programs in abortion, adolescent sexual and reproductive health, women and girls’ empowerment, maternal and child health, nutrition, water and sanitation, menstrual hygiene management, neglected tropical diseases (schistosomiasis), sample vital registration systems, and primary health care.

The project employs a network of female resident enumerators recruited from near the selected survey clusters who are trained to use smartphones to gather survey data. The PMA platform has been deployed in 11 countries so far with plans to expand. Countries include Ghana, Democratic Republic of Congo, Ethiopia, Uganda, Burkina Faso, Niger, Nigeria, Indonesia, India, Cote d’Ivoire, and Kenya.

For more information please visit pmadata.org .

The predictive utility of unmet need and intentions to use contraception in Uganda

Amy Tsui, Scott Radloff, Saifuddin Ahmed The study team is assessing the predictive utility of a leading indicator, unmet need for contraception, and that of a less prominent one, future intention to use, as influencing contraceptive adoption, using data from a four-year panel follow-up of a national sample of Ugandan women.

Quality improvement to integrate HIV testing in the Harriet Lane Clinic’s Title X Program

Arik V. Marcell Funded by the Office of Population Affairs, the goal of this program is to integrate rapid HIV testing as part of Title X services and increase the proportion of clients receiving HIV test results and evaluate increased use using rapid Plan-Do-Study-Act cycles.

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The Biden-Harris Administration Issues New Rule to Support Reproductive Health Care Privacy Under HIPAA

The Final Rule strengthens privacy protections for medical records and health information for women, their family members, and doctors who are seeking, obtaining, providing, or facilitating lawful reproductive health care.

Today, the Biden-Harris Administration, through the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) announced a Final Rule, entitled HIPAA Privacy Rule to Support Reproductive Health Care Privacy . The Final Rule strengthens the Health Insurance Portability Act of 1996 (HIPAA) Privacy Rule by prohibiting the disclosure of protected health information (PHI) related to lawful reproductive health care in certain circumstances. HHS is issuing this Final Rule after hearing from communities that changes were needed to better protect patient confidentiality and prevent medical records from being used against people for providing or obtaining lawful reproductive health care. This Final Rule will bolster patient-provider confidentiality and help promote trust and open communication between individuals and their health care providers or health plans, which is essential for high-quality health care.

“Many Americans are scared their private medical information will be being shared, misused, and disclosed without permission. This has a chilling effect on women visiting a doctor, picking up a prescription from a pharmacy, or taking other necessary actions to support their health,” said HHS Secretary Xavier Becerra. “The Biden-Harris Administration is providing stronger protections to people seeking lawful reproductive health care regardless of whether the care is in their home state or if they must cross state lines to get it. With reproductive health under attack by some lawmakers, these protections are more important than ever.”

“Since the fall of Roe v. Wade , providers have shared concerns that when patients travel to their clinics for lawful care, their patients’ records will be sought, including when the patient goes home. Patients and providers are scared, and it impedes their ability to get and to provide accurate information and access safe and legal health care,” said OCR Director Melanie Fontes Rainer. “Today’s rule prohibits the use of protected health information for seeking or providing lawful reproductive health care and helps maintain and improve patient-provider trust that will lead to improved health outcomes and protect patient privacy.”

OCR administers and enforces the Privacy Rule, which requires most health care providers, health plans, health care clearinghouses, and business associates (collectively, “regulated entities”) to safeguard the privacy of PHI and sets limits and conditions on the uses and disclosures of such information. The HIPAA Privacy Rule also gives individuals certain rights over their PHI. In April 2023, OCR published proposed modifications to the HIPAA Privacy Rule to address changes in the legal landscape affecting reproductive health care privacy that make it more likely than before that PHI may be used and disclosed in ways that HIPAA intended to protect. OCR received almost 30,000 comments on the proposed rule from the public. After carefully considering these comments, the Department is issuing a Final Rule that:

• Prohibits the use or disclosure of PHI when it is sought to investigate or impose liability on individuals, health care providers, or others who seek, obtain, provide, or facilitate reproductive health care that is lawful under the circumstances in which such health care is provided, or to identify persons for such activities.
• Requires a regulated health care provider, health plan, clearinghouse, or their business associates, to obtain a signed attestation that certain requests for PHI potentially related to reproductive health care are not for these prohibited purposes.
• Requires regulated health care providers, health plans, and clearinghouses to modify their Notice of Privacy Practices to support reproductive health care privacy.

The Final Rule may be viewed here .

View The Final Rule Fact Sheet here .

The current HIPAA Privacy Rule is in effect until the new rule takes effect. If you believe that your (or someone else’s) health information privacy rights or other Privacy, Security, or Breach Notification rules have been violated, you may file a complaint with the HHS Office for Civil Rights at: https://www.hhs.gov/hipaa/filing-a-complaint/index.html .

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Unpacking 5 truths about equality in sexual and reproductive health and rights today

• 16 April 2024

UNITED NATIONS, New York – Over the past 30 years, global commitments to sexual and reproductive health and rights have made remarkable advances: Maternal death rates have dropped by almost a third, the number of women using modern contraception has doubled and more than 160 countries have passed laws against domestic violence.

A new report by UNFPA, the United Nations sexual and reproductive health agency, traces the path that led to this progress and empowered millions with increased freedom and autonomy. But it also lays bare how little these improvements have affected the world’s poorest and most marginalized, for whom rights and choices remain largely out of reach.

These disparate realities are driven by inequality and discrimination, often hidden within our health systems and economic, social and political institutions. Achieving equity, then, requires exposing inequalities so that inclusive solutions can be imagined and implemented.

Below, read about where and how inequality shows up in our societies, lifting some communities up while pushing others behind – and about what can be done to counteract it and ensure a peaceful, prosperous future for all.

1. Inequalities in sexual and reproductive health and rights are everywhere .

In Ashgabat, Turkmenistan, Alia* and her husband were told that it was “undesirable” for them to have a baby. The reason? They were both blind.

Women and girls with disabilities often face discrimination when it comes to sexual and reproductive health, limited access to services and exclusion from comprehensive sexuality education. Some are even forcibly sterilized.

The particular challenges Alia and other women with disabilities face during pregnancy and childbirth reinforce one of the report’s main themes: That access to health and rights vary greatly from one region, country and person to another.

Disability status represents just one facet of identity that affects the right to health. Geography is another, with women in Africa around 130 times more likely to die from pregnancy complications than women in Europe. And as for women and girls from ethnic minorities, disparities in health-care access were found in all countries surveyed for UNFPA’s report.

2. Progress on sexual and reproductive health for all is stalling, and by many counts, unravelling.

For nearly 20 years, the global annual reduction in maternal deaths has been zero – meaning there has been no progress. Meanwhile, one quarter of women today report not being able to say no to sex with their husband or partner.

This means that despite investments, advocacy and rafts of legislation, women’s ability to exercise decision-making over their own bodies is diminishing. And while barriers to health have fallen quickly for the most privileged, they are standing firm for the most disadvantaged.

“Even in better-off countries, maternal death rates are higher among communities that continue to confront racial and other prejudices in everyday life,” UNFPA Executive Director Dr. Natalia Kanem said in her World Health Day statement . “We can and must do better.”

3. Sexual and reproductive health and rights are being politicized – and opinions polarized.

As half the world goes to the polls this year, many leaders have decided to base their political strategies on sowing division.

Anxieties over migration as well as low- and high-fertility rates are being weaponized by some policymakers to strike down sexual and reproductive health and rights agreements. Meanwhile others are making their legal systems less equitable by decriminalizing female genital mutilation or restricting the rights of LGBTQIA+ people, for instance.

Harmful stereotypes about women, girls and people with diverse sexual orientations and gender identities are too often peddled to justify gender inequality and homophobia, with dangerous consequences. As Efram*, a refugee from Syria who was struggling to access sexual health care in a new country, explained to UNFPA: “I can’t tell anyone that I’m gay because of the stigma. We are not recognized, and we don’t have any kind of rights”.

4.But there is hope: Where inequalities exist, community leaders are helping to bridge gaps in services.

Gender inequality, racial discrimination and misinformation are deeply embedded in many health systems: UNFPA research has found that in the Americas, Afrodescendent women are more likely to die during childbirth due in part to racist abuse in the health sector.

For these reasons and others – including cost and distance to facilities – Afrodescendent women may avoid going to hospitals for health care. “It wasn’t the environment I wanted,” Shirley Maturana Obregón from Colombia told UNFPA about her birth plan.

Instead, she delivered with a partera, a traditional birth attendant and practitioner of knowledge ancestral to Colombia’s Afrodescendent community.

Parteras provide culturally sensitive care among Colombian communities that remain largely disconnected from the country’s formal health system – and for whom getting to a doctor can require expensive travel across hazardous, conflict-affected terrain.

Ms. Maturana Obregón said her delivery with a partera was beautiful and unforgettable; she later became a traditional birth attendant herself. “We are there, making women’s dreams come true,” she said.

5. Progress is achievable, but we must reject division and embrace collaboration.

UNFPA’s report shows above all that we cannot divide and conquer on our way to ensuring universal health and rights. Rather, we must find political consensus, tailor solutions to communities and mobilize urgent funding to achieve our aims.

Grassroots leaders are essential to this work: Sarah Sy Savané, who advocates against female genital mutilation and child marriage in Côte d’Ivoire, says programmes aimed at eliminating harmful practices are designed by people working in the communities they target. “Safe spaces, husbands’ clubs and other interventions are making a real difference, shining a light where young girls thought they had no rights,” she told UNFPA.

Initiatives like these have tangible impacts, but they need more support. Spending an additional $79 billion in low- and middle-income countries by 2030 would avert 400 million unplanned pregnancies, save 1 million lives and generate $660 billion in economic benefits. Training more midwives could also prevent about 40 per cent of maternal and neonatal deaths and over a quarter of stillbirths. 

Funding saves lives, while a lack of investment endangers them.

The truth is that inequality is everywhere we look – and once its devastating consequences have been revealed, they cannot be unseen. As UNFPA Executive Director Dr. Natalia Kanem said, “We have every reason to act – for human rights, for gender equality, for justice and for the world’s bottom line.

There is only one way to achieve a future of dignity and rights for all: By working together.”

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• Maternal health
• Comprehensive sexuality education

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Key facts about the abortion debate in America

The U.S. Supreme Court’s June 2022 ruling to overturn Roe v. Wade – the decision that had guaranteed a constitutional right to an abortion for nearly 50 years – has shifted the legal battle over abortion to the states, with some prohibiting the procedure and others moving to safeguard it.

As the nation’s post-Roe chapter begins, here are key facts about Americans’ views on abortion, based on two Pew Research Center polls: one conducted from June 25-July 4 , just after this year’s high court ruling, and one conducted in March , before an earlier leaked draft of the opinion became public.

This analysis primarily draws from two Pew Research Center surveys, one surveying 10,441 U.S. adults conducted March 7-13, 2022, and another surveying 6,174 U.S. adults conducted June 27-July 4, 2022. Here are the questions used for the March survey , along with responses, and the questions used for the survey from June and July , along with responses.

Everyone who took part in these surveys is a member of the Center’s American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses. This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories.  Read more about the ATP’s methodology .

A majority of the U.S. public disapproves of the Supreme Court’s decision to overturn Roe. About six-in-ten adults (57%) disapprove of the court’s decision that the U.S. Constitution does not guarantee a right to abortion and that abortion laws can be set by states, including 43% who strongly disapprove, according to the summer survey. About four-in-ten (41%) approve, including 25% who strongly approve.

About eight-in-ten Democrats and Democratic-leaning independents (82%) disapprove of the court’s decision, including nearly two-thirds (66%) who strongly disapprove. Most Republicans and GOP leaners (70%) approve , including 48% who strongly approve.

Most women (62%) disapprove of the decision to end the federal right to an abortion. More than twice as many women strongly disapprove of the court’s decision (47%) as strongly approve of it (21%). Opinion among men is more divided: 52% disapprove (37% strongly), while 47% approve (28% strongly).

About six-in-ten Americans (62%) say abortion should be legal in all or most cases, according to the summer survey – little changed since the March survey conducted just before the ruling. That includes 29% of Americans who say it should be legal in all cases and 33% who say it should be legal in most cases. About a third of U.S. adults (36%) say abortion should be illegal in all (8%) or most (28%) cases.

Generally, Americans’ views of whether abortion should be legal remained relatively unchanged in the past few years , though support fluctuated somewhat in previous decades.

Relatively few Americans take an absolutist view on the legality of abortion – either supporting or opposing it at all times, regardless of circumstances. The March survey found that support or opposition to abortion varies substantially depending on such circumstances as when an abortion takes place during a pregnancy, whether the pregnancy is life-threatening or whether a baby would have severe health problems.

While Republicans’ and Democrats’ views on the legality of abortion have long differed, the 46 percentage point partisan gap today is considerably larger than it was in the recent past, according to the survey conducted after the court’s ruling. The wider gap has been largely driven by Democrats: Today, 84% of Democrats say abortion should be legal in all or most cases, up from 72% in 2016 and 63% in 2007. Republicans’ views have shown far less change over time: Currently, 38% of Republicans say abortion should be legal in all or most cases, nearly identical to the 39% who said this in 2007.

However, the partisan divisions over whether abortion should generally be legal tell only part of the story. According to the March survey, sizable shares of Democrats favor restrictions on abortion under certain circumstances, while majorities of Republicans favor abortion being legal in some situations , such as in cases of rape or when the pregnancy is life-threatening.

There are wide religious divides in views of whether abortion should be legal , the summer survey found. An overwhelming share of religiously unaffiliated adults (83%) say abortion should be legal in all or most cases, as do six-in-ten Catholics. Protestants are divided in their views: 48% say it should be legal in all or most cases, while 50% say it should be illegal in all or most cases. Majorities of Black Protestants (71%) and White non-evangelical Protestants (61%) take the position that abortion should be legal in all or most cases, while about three-quarters of White evangelicals (73%) say it should be illegal in all (20%) or most cases (53%).

In the March survey, 72% of White evangelicals said that the statement “human life begins at conception, so a fetus is a person with rights” reflected their views extremely or very well . That’s much greater than the share of White non-evangelical Protestants (32%), Black Protestants (38%) and Catholics (44%) who said the same. Overall, 38% of Americans said that statement matched their views extremely or very well.

Catholics, meanwhile, are divided along religious and political lines in their attitudes about abortion, according to the same survey. Catholics who attend Mass regularly are among the country’s strongest opponents of abortion being legal, and they are also more likely than those who attend less frequently to believe that life begins at conception and that a fetus has rights. Catholic Republicans, meanwhile, are far more conservative on a range of abortion questions than are Catholic Democrats.

Women (66%) are more likely than men (57%) to say abortion should be legal in most or all cases, according to the survey conducted after the court’s ruling.

More than half of U.S. adults – including 60% of women and 51% of men – said in March that women should have a greater say than men in setting abortion policy . Just 3% of U.S. adults said men should have more influence over abortion policy than women, with the remainder (39%) saying women and men should have equal say.

The March survey also found that by some measures, women report being closer to the abortion issue than men . For example, women were more likely than men to say they had given “a lot” of thought to issues around abortion prior to taking the survey (40% vs. 30%). They were also considerably more likely than men to say they personally knew someone (such as a close friend, family member or themselves) who had had an abortion (66% vs. 51%) – a gender gap that was evident across age groups, political parties and religious groups.

Relatively few Americans view the morality of abortion in stark terms , the March survey found. Overall, just 7% of all U.S. adults say having an abortion is morally acceptable in all cases, and 13% say it is morally wrong in all cases. A third say that having an abortion is morally wrong in most cases, while about a quarter (24%) say it is morally acceptable in most cases. An additional 21% do not consider having an abortion a moral issue.

Among Republicans, most (68%) say that having an abortion is morally wrong either in most (48%) or all cases (20%). Only about three-in-ten Democrats (29%) hold a similar view. Instead, about four-in-ten Democrats say having an abortion is morally  acceptable  in most (32%) or all (11%) cases, while an additional 28% say it is not a moral issue. 

White evangelical Protestants overwhelmingly say having an abortion is morally wrong in most (51%) or all cases (30%). A slim majority of Catholics (53%) also view having an abortion as morally wrong, but many also say it is morally acceptable in most (24%) or all cases (4%), or that it is not a moral issue (17%). Among religiously unaffiliated Americans, about three-quarters see having an abortion as morally acceptable (45%) or not a moral issue (32%).

• Religion & Abortion

What the data says about abortion in the U.S.

Support for legal abortion is widespread in many countries, especially in europe, nearly a year after roe’s demise, americans’ views of abortion access increasingly vary by where they live, by more than two-to-one, americans say medication abortion should be legal in their state, most latinos say democrats care about them and work hard for their vote, far fewer say so of gop, most popular.

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Stop COVID Cohort: An Observational Study of 3480 Patients Admitted to the Sechenov University Hospital Network in Moscow City for Suspected Coronavirus Disease 2019 (COVID-19) Infection

Collaborators.

• Sechenov StopCOVID Research Team : Anna Berbenyuk ,  Polina Bobkova ,  Semyon Bordyugov ,  Aleksandra Borisenko ,  Ekaterina Bugaiskaya ,  Olesya Druzhkova ,  Dmitry Eliseev ,  Yasmin El-Taravi ,  Natalia Gorbova ,  Elizaveta Gribaleva ,  Rina Grigoryan ,  Shabnam Ibragimova ,  Khadizhat Kabieva ,  Alena Khrapkova ,  Natalia Kogut ,  Karina Kovygina ,  Margaret Kvaratskheliya ,  Maria Lobova ,  Anna Lunicheva ,  Anastasia Maystrenko ,  Daria Nikolaeva ,  Anna Pavlenko ,  Olga Perekosova ,  Olga Romanova ,  Olga Sokova ,  Veronika Solovieva ,  Olga Spasskaya ,  Ekaterina Spiridonova ,  Olga Sukhodolskaya ,  Shakir Suleimanov ,  Nailya Urmantaeva ,  Olga Usalka ,  Margarita Zaikina ,  Anastasia Zorina ,  Nadezhda Khitrina

Affiliations

• 1 Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 2 Inflammation, Repair, and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom.
• 3 Soloviev Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
• 4 School of Physics, Astronomy, and Mathematics, University of Hertfordshire, Hatfield, United Kingdom.
• 5 Biobank, Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 6 Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 7 Chemistry Department, Lomonosov Moscow State University, Moscow, Russia.
• 8 Department of Polymers and Composites, N. N. Semenov Institute of Chemical Physics, Moscow, Russia.
• 9 Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
• 10 Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany.
• 11 Institute for Urology and Reproductive Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 12 Department of Intensive Care, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 13 Clinic of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 14 Department of Internal Medicine No. 1, Institute of Clinical Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 15 Department of Forensic Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• 16 Department of Statistics, University of Oxford, Oxford, United Kingdom.
• 17 Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
• 18 Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
• 19 Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom.
• 20 Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
• PMID: 33035307
• PMCID: PMC7665333
• DOI: 10.1093/cid/ciaa1535

Background: The epidemiology, clinical course, and outcomes of patients with coronavirus disease 2019 (COVID-19) in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically diagnosed COVID-19 in real-life settings is lacking.

Methods: We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow between 8 April and 28 May 2020.

Results: Of the 4261 patients hospitalized for suspected COVID-19, outcomes were available for 3480 patients (median age, 56 years; interquartile range, 45-66). The most common comorbidities were hypertension, obesity, chronic cardiovascular disease, and diabetes. Half of the patients (n = 1728) had a positive reverse transcriptase-polymerase chain reaction (RT-PCR), while 1748 had a negative RT-PCR but had clinical symptoms and characteristic computed tomography signs suggestive of COVID-19. No significant differences in frequency of symptoms, laboratory test results, and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR. In a multivariable logistic regression model the following were associated with in-hospital mortality: older age (per 1-year increase; odds ratio, 1.05; 95% confidence interval, 1.03-1.06), male sex (1.71; 1.24-2.37), chronic kidney disease (2.99; 1.89-4.64), diabetes (2.1; 1.46-2.99), chronic cardiovascular disease (1.78; 1.24-2.57), and dementia (2.73; 1.34-5.47).

Conclusions: Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features was sufficient to diagnose COVID-19 infection, indicating that laboratory testing is not critical in real-life clinical practice.

Keywords: COVID-19; Russia; SARS-CoV-2; cohort; mortality risk factors.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].

Publication types

• Observational Study
• Research Support, Non-U.S. Gov't
• Hospitalization
• Middle Aged

Grants and funding

• 20-04-60063/Russian Foundation for Basic Research