Restrictive abortion laws in many African nations are associated with risks such as unsafe procedures and teenage motherhood. This study examines how abortion legalization influences sexual and reproductive health and women's empowerment in South Africa, using a difference-in-differences design. Analyzing variations in birth cohorts and access to health care facilities with abortion services across provinces, the study finds no direct causal impact of the abortion policy on teenage motherhood, fertility rates, early sexual debut, high school completion, or college attendance, though negative associations with teenage motherhood and fertility rates and positive associations with early sexual debut, high school completion, and college attendance, were observed. The study suggests that limited access to health care facilities with abortion services and cultural taboos contribute to underreporting of behaviors. Given these findings, we recommend prioritizing access to contraception and creating supportive environments for adolescent girls living in vulnerable situations, including improved access to health care facilities that offer abortion services.
Purpose Many predicted that COVID-19 would have a substantial impact on the sexual and reproductive health (SRH) trajectories of adolescents in sub-Saharan Africa. The lack of longitudinal data with information collected before and into the pandemic has limited investigation into this topic. Methods We performed a secondary analysis using nationally representative longitudinal data from Kenya and Burkina Faso, collected at three time points (pre-COVID-19 in late 2019, and during COVID-19 in 2020 and 2021), to determine the extent to which SRH outcomes and behaviors, including pregnancy, contraceptive use, partnership status, and sexual activity, changed during the pandemic among adolescent women. Results Among adolescents aged 15-19 years (Kenya n = 1,893, Burkina Faso n = 1,422), there was a reduction in both partnership and pregnancy in 2021 as compared to pre-COVID 2019. Contraception use significantly increased between 2019 and 2021 in Kenya only (adjusted odds ratio [aOR]: 1.42, 95% confidence interval [CI] 1.03-1.97). COVID-19-related household income loss was associated with a decline in sexual activity among unmarried Kenyan girls (aOR: 0.47, 95% CI 0.25-0.87) and lower odds of pregnancy in Burkina Faso (aOR: 0.13, 95% CI 0.02-0.91). We did not find a relationship between COVID-19 measures and initiation of partnership or marriage in either setting. Discussion Contrary to expectations, our results suggest that COVID-19 did not have a consistent or sustaining impact on adolescent SRH and behaviors in Burkina Faso and Kenya. Further research is needed to assess the longer-term implications of the pandemic on adolescent social and health outcomes.
The human papillomavirus (HPV) is the leading cause of cervical and oropharyngeal cancers. Vaccination can prevent over 90% of HPV-attributed cancers. Rural populations are less likely to initiate and complete HPV vaccinations than urban. The primary objective of this paper is to systematically examine the multilevel (child/youth, parent/caregiver, physician/team, healthcare organization, community, and policy) influences on HPV vaccine uptake in the rural US population. As a secondary aim, we seek to identify gaps in the research that could contribute to the development of more precise intervention approaches in this population. The study adds to the limited number of recent reviews on rural HPV vaccine uptake in the US. Method We conducted a systematic search of published empirical studies over 13 years (2010-2023), resulting in 1657 publications. The following databases were searched: Medline (OVID), Embase, CINAHL, PsychInfo, Cochrane, Sociological Abstracts, and Scopus using pre-specified inclusion criteria. Two reviewers independently coded 101 full texts; discrepancies were resolved by a third reviewer. The primary outcome was HPV vaccine uptake. Results Adolescents themselves were the most common foci of change. Barriers to rural HPV uptake included limited; vaccine awareness, access to vaccines for children vaccination sites, and primary care recommendations. Conclusions Tailored interventions to rural parents/caregivers could increase uptake of the vaccine. Provider training increases HPV vaccine recommendations; programs should also be targeted to rural school nurses, pharmacists, and dental care providers. Linking primary care practices and public health dissemination strategies are key.
Introduction Parental marital status is a pivotal determinant of adolescent maladaptive behaviors. However, the specific correlation between parental marital status and Non-Suicidal Self-Injury (NSSI) among adolescents in western China has not been thoroughly investigated. Methods A cross-sectional study was conducted involving 7,274 students from non-divorced families and 1,332 from divorced families. Participants were assessed using the Ottawa Self-Injury Inventory (OSI) and the Depression, Anxiety, and Stress Scale-21 Items (DASS-21). Propensity score matching (PSM) was applied to control for confounders, and logistic regression was used to analyze associations. Results The prevalence of non-suicidal self-injury (NSSI) was higher in adolescents from non-divorced families (4.1%) than in those from divorced families (1.6%). However, propensity score matching analysis revealed that parental divorce was associated with a significantly increased odds of NSSI after controlling for confounders. Furthermore, depression and anxiety were identified as independent risk factors for NSSI. Mediation analysis indicated that the emotional distress (depression, anxiety, and stress) did not significantly mediate the relationship between parental divorce and NSSI. Additional significant predictors of NSSI included girls and age. Discussion Adolescents from divorced families in western China show a higher incidence of NSSI, though this relationship is not mediated by emotional distress. These findings highlight the need for families and society to enhance attention to the psychological well-being of this vulnerable adolescent population.
Background Creative and arts-based techniques are increasingly integrated into child and adolescent psychotherapy, yet little is known about how they are applied in routine practice and whether their use differs when working with racially minoritized youth. This study examined the prevalence, clinical functions, and contextual positioning of art-based techniques among therapists in Germany, with a focus on identity-informed applications in work with clients of Color and clients from Black ethnic groups. Methods This study reports data from the German arm of the CREATE project, an online cross-sectional mixed-methods research initiative conducted in Germany and the United Kingdom. Therapists working with children and adolescents (N = 98; Mean age = 36.60, SD = 9.84) completed quantitative items on use, goals, and perceived preparedness across client contexts (general vs. PoC vs. Black), and provided open-ended responses on strengths, challenges, and barriers. Quantitative analyses used descriptive statistics and non-parametric within-therapist comparisons; qualitative data were analyzed via framework analysis. Results Overall, 62.2% of therapists reported using art-based techniques (51.0% exclusively; 11.2% combined with music-based methods). Use was most frequent in individual settings and was primarily described as transdiagnostic, targeting emotional access, engagement, nonverbal communication, and experiential processing; diagnosis-specific mentions were less common (most often anxiety, ADHD, depression, and trauma-related symptoms). Therapists with experience working with BIPoC clients and with non-binary clients were more likely to use art-based techniques. Within-therapist comparisons showed significantly lower perceived preparedness in PoC contexts, alongside reduced endorsement of art-based techniques for relationship-building and for supporting nonverbal communication of difficult-to-express experiences. Qualitative findings highlighted benefits for communication, emotional expression, access to avoided topics, and self-efficacy, while barriers centered on limited training, institutional constraints, and uncertainty about structuring and integrating techniques. Only 17.3% reported racism-informed training and 4.1% training on racial trauma. Conclusions Art-based techniques are widely valued and used flexibly in German routine child and adolescent psychotherapy, predominantly as transdiagnostic, process-oriented tools. However, their positioning in minoritized contexts appears shaped by lower therapist preparedness and limited racism-informed training. Integrating structured training in creative techniques alongside culturally responsive and racism-informed psychotherapy may support more confident, relational, and identity-informed application in diverse youth populations.
Globally, more than 12 million girls under the age of 18 are forced to marry every year. Progress on ending child marriage in the Arab region is slowing, and risks being reversed, due to an increase in conflict-affected populations and widespread economic crisis. The aim of this paper is to consider the research priorities across the region to inform effective and accelerated child marriage prevention and response programming within the Arab region. Seventy-three specialists supporting child marriage prevention and response programming in the Arab region engaged with up to three phases of an online Delphi consultation process on research gaps and the research environment between July 2019 and December 2021. Proposals of research gaps were elicited, reviewed, and rated by participants to confirm a shared learning agenda. Participants identified 50 different research gaps across 7 main areas, reaching a high level of consensus support for 23 of 50 statements. Clear consensus was reached in relation to an increased need to produce and use evidence to support programme development, and further research on specific drivers and consequences of child marriage. The least consensus was found in relation to how research can inform prevention and response efforts within the law and legal system. The results provide the foundation of a child marriage research agenda for the Arab region which takes into account regional distinctiveness and builds on the global momentum for child marriage research. Mechanisms are in place to do this through the Regional Action Forum, and other networks across the region.
Introduction Industrial automation is profoundly transforming the labor market, yet it may also impose hidden costs beyond economic outcomes. In particular, heightened labor market competition caused by robot adoption may create intergenerational costs, such as adverse effects on children's mental health. Methods This study combines survey data from the 2012-2020 China Family Panel Studies with robot data from the International Federation of Robotics to investigate the impact of automation on the mental health of Chinese children. To address endogeneity concerns, we construct an instrumental variable for domestic robot adoption using U.S. robot data and employ a two-stage least squares (2SLS) approach. Results The findings reveal that a one-standard deviation increase in robot adoption (0.414 robots per thousand workers) increases the likelihood of severe depression among Chinese children by 0.75 percentage points. These adverse effects are largely mediated by heightened academic pressure and reduced positive parent-child interactions. Furthermore, the effects are stronger among girls and children living in urban areas. Discussion This study advances understanding of the broader social implications of automation. It highlights the often-overlooked psychological costs of automation, demonstrating that its effects extend beyond the current workforce to future generations.
Background Teenage pregnancy rates have globally decreased over the years, but remain high, especially in low- and middle-income countries (LMICs). Among girls aged 15-19, teenage pregnancy remains the leading cause of death and a significant barrier to education and productivity. Its prevalence was high in pakwach district as reported by the DHO and police report during the pandemic. However, limited data exist regarding factors contributing to its rise during the COVID-19 pandemic in Uganda. This study explores the factors associated with teenage pregnancy in Pakwach district during this period. Methods We conducted a matched case-control study, enrolling 362 teenage girls aged 10-19 years, divided into two groups: 181 pregnant teenagers and 181 non-pregnant teenagers. We collected exposure data from both groups using a questionnaire to assess factors associated with teenage pregnancy. The study period covered March 2020 to January 2021, coinciding with lockdown measures. Results During the COVID-19 period, teenage pregnancies were only associated with having exclusively female peers (AOR 3.0, 95% CI: 0.1-104.4). Conversely, having a Radio/TV at home (AOR 0.2, 95% CI: 0.1-0.6), age at first sexual encounter (AOR 0.1, 95% CI: 0.03-0.9), considering teenage pregnancy as sexual abuse (AOR 0.1, 95% CI: 0.02-0.4), feeling comfortable asking questions during consultations (AOR 0.5, 95% CI: 0.2-1.3), and ensuring sufficient privacy during consultations were protective against teenage pregnancy. Conclusion The factors contributing to increased teenage pregnancies during the COVID-19 pandemic were consistent with long-standing contextual factors associated with teenage pregnancy. The lockdown environment may have slightly exacerbated these factors, but no direct association was observed. Only having female peers was linked to teenage pregnancy during the lockdown. But more importantly for our study population, having access to a radio/TV at home and other healthcare system-related factors were protective during the lockdown. Therefore, interventions should be focused on making pregnancy prevention information available to teenagers during any lockdown scenario.
Abstract Introduction Based on the United Nations' sustainable development goals, universal access to sexual and reproductive health (SRH) services should be attained by 2030. Yet, large inequalities in adolescent SRH knowledge and service use still exist both within and between countries. The goal of this study was to identify and synthesise published qualitative research on factors affecting young people's utilisation of SRH services in Asia-Pacific countries. Methods We systematically searched five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science) for qualitative studies reporting the experiences, attitudes and views of young people (aged 10-24 years) regarding the utilisation of SRH services in Asia-Pacific countries. We assessed the quality of identified studies using the Critical Appraisal Skills Programme qualitative checklist and employed a thematic synthesis approach for the data analysis. Results We included 31 articles that reported the experiences of over 1800 young people from 15 different countries. Thematic synthesis identified six descriptive themes that captured factors influencing SRH service utilisation: (1) navigating puberty; (2) knowledge and beliefs about SRH; (3) embarrassment and confidentiality concerns; (4) low decision-making autonomy; (5) traditional practices and religious beliefs; and (6) social and gender norms. Based on these, we developed an overarching analytical theme, 'trapped in a legacy of shame', which highlights the role of shame as a key emotion associated with young people's utilisation of SRH services. Conclusion Our findings point towards the necessity of integrating shame-sensitive approaches and a social norms perspective in interventions aiming to improve young people's SRH outcomes in Asia-Pacific countries. Prospero registration number CRD42023389653.
Background Infant mortality remains a critical public health concern, necessitating a comprehensive understanding of its determinants. This investigation aimed to examine associations between social determinants, lifestyle factors, and maternal mental health in relation to infant mortality. Methods A cross-sectional survey was conducted among 500 mothers (250 rural, 250 urban) in Khyber Pakhtunkhwa (KPK), Pakistan. The Depression Anxiety Stress Scales (DASS-21) were employed to evaluate symptoms of anxiety, depression, and stress, while a Lifestyle and Habits Questionnaire collected data on physical activity and dietary patterns. Data was collected via questionnaires and demographic information from 500 mothers using purposive sampling. Key variables included rural/urban residence, age at marriage, socio-economic status, access to healthcare, type of delivery attendant, and under-5 mortality rates. Results Rural mothers had significantly lower infant mortality rates (p = 0.000) compared to urban mothers. Physical activity and diet were negatively correlated with depression, anxiety, and stress (p < 0.05). Rural mothers reported higher physical activity (M = 23.46 vs. 21.79, p = 0.001) and healthier diets (M = 16.01 vs. 14.85, p = 0.001). Urban mothers exhibited significantly higher levels of depression (M = 6.59 vs. 1.63, p = 0.000), anxiety (M = 7.68 vs. 2.18, p = 0.000), and stress (M = 9.65 vs. 2.32, p = 0.000). Early marriage was linked to increased anxiety and stress (p = 0.000). Conclusion Findings underscored the importance of addressing social determinants and fostering healthy lifestyles to improve maternal and child health outcomes. Interventions that promote access to healthcare, physical activity or healthy dietary habits can help make the infant mortality rates and the overall state of health of the mother better.
