Sexual and Reproductive Health

Danielle Mazza, MD, MBBS, FRACGP, DRANZCOG, Grad Dip Women's Health, GAICD, CF

Jessica R. Botfield, BN, MPH, MIPH, PhD

Contraception, preconception care, and abortion are integral and intertwined aspects of women's reproductive health. We know that nearly half of all pregnancies worldwide are unintended, which can have significant consequences for women, girls, and society more broadly.[1] Over 60% of unintended pregnancies, and almost 30% of all pregnancies, end in abortion (noting that nearly half of all abortions performed globally are unsafe).[1] Most unintended pregnancies can be attributed to non- or incorrect use of contraception or contraceptive failure,[2] [3] yet there are approximately 257 million women globally who want to avoid pregnancy but are not using a safe, modern method of contraception due to lack of access.[1] It is therefore imperative that women are able to access effective methods of contraception, support in pregnancy planning, and abortion care so they can achieve their reproductive life goals.

In this issue, we address these aspects of reproductive health. We examine the tools available to evaluate pregnancy intention and the implications of their use for policy and practice. Understanding pregnancy intentions can help women (and the clinicians supporting them) make decisions about contraception to suit their needs. We explore the opportunities for increasing access to effective contraception, using examples from the Australian context, and consider how to improve access to and quality of postpartum contraception provision. We present a common clinical scenario, that of obesity among women of reproductive age seeking contraception and discuss the considerations and approaches for facilitating provision of inclusive contraceptive care for this population group. This includes a review of current evidence on method-specific advantages and disadvantages for people with obesity to guide practice and policy. Finally, we present several articles relating to medical abortion, including a systematic review relating to another common clinical scenario, that of very early medical abortion (VEMA), to report the current evidence on efficacy, safety, and treatment success of VEMA. We conclude with two case studies from Canada: one focused on access to abortion care for incarcerated people and another on the deregulation of medical abortion to support access to safe, early abortion care in primary care settings.

The articles in this issue will be of interest to clinicians as well as public health–focused researchers and decision-makers. The issue provides an overview of current global challenges in reproductive health and provides reviews of the evidence to guide clinical practice and public health responses to key issues relating to pregnancy intention, contraception, and abortion care.

Publication History

Article published online:
06 February 2023

• References

• 1 UNFPA. State of World Population 2022. New York: UNFPA; 2022
• 2 Rowe H, Holton S, Kirkman M. et al. Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey. Aust N Z J Public Health 2016; 40 (02) 104-109
• 3 Harney C, Dude A, Haider S. Factors associated with short interpregnancy interval in women who plan postpartum LARC: a retrospective study. Contraception 2017; 95 (03) 245-250