1. Global Reproductive health

Question 1

global indicators of women’s reproductive health

Answer 1

• onset of menarche
• rates of caesarean births
• infertility
• sexual and gender minority health
• cervical cancer

Question 2

what and who does womens reproductive health relate

Answer 2

• the medical and biological care of anyone who has (ovaries, uterus, cervix, vagina, breasts);
• at any stage of life after menarche,
• the social, economic and political context in which that person is
  situated, and;

Question 3

what is important to remember when looking at systematic reviews and meta analysis

Answer 3

• know what we are looking at
• know limitations, small samples or unrepresentative samples
• definitions and key terms being consistent
• Social and cultural factors help to determine who we
  ‘see’ and ‘don’t see’ in research
• When you can’t ‘see’ a population, it’s very hard to collect data
  – invisibility due to legal penalties,
  stigma, lack of knowledge,
• Population can be mistrustful of researchers: can
  provide ‘socially desirable’ responses rather than
  reflecting reality
• ‘Research fatigue’
• When there is limited data, it’s really hard to develop evidence-based interventions
• Be culturally and socially aware of the population
  you’re studying – know the context – this affects
  the quality of the data
• Remember to ask why certain data is missing
• Check the quality of local data collection

Question 4

what did we find on sexual and gender minorities reproductive health

Answer 4

Research was limited in scope, concentrating mostly on HIV and STIs and MSM
- Transwomen at far higher risk of HIV, STIs
- Very limited good-quality studies on WSW
- Positive association between a history of female sexual
partners and risk of bacterial vaginosis
- No evidence of a higher burden of STIs in WSW
compared with the general population of adult women
- No convincing evidence of a higher disease burden of breast cancer in WSW
- However: far higher rates of mental health disorders and suicide attempts; physical and sexual assaults; drug use
- Mental disorders, suicidality, assault, and substance use all pose risks in reproductive health

Question 5

cervical cancer rates

Answer 5

• 10-fold or greater variation in rates between countries within regions.
• Northern Europe: high rates in Lithuania but low rates in Finland.
• Poor quality data from countries without population based screening, or with poor-quality and inconsistent screening.
• Absence of data from the Middle East in this paper GLOBOCAN data shows cervical cancer incidence, but this paper has no data on HPV incidence.
• ‘Burden of Human Papillomavirus Infections and
  Related Diseases in the Extended Middle East and North Africa Region’(2013)
• Confirmed poor quality data collection locally

Question 6

in summary

Answer 6

• Understand the risks of generalising from local to national, and vice versa (sample sizes matter!)
• Be aware of regional and local variations
• Know exactly how a health problem has been defined in any particular study
• Know the context: finding ‘invisible’ populations
• How reliable is the data collection?
• Develop a healthy skepticism overall!