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Background: Despite the availability of cervical cancer (CC) screening in Bolivia, coverage remains low and uneven across municipalities. This suggests the presence of barriers to effective secondary prevention, which involves early detection through screening and treatment of precancerous lesions. There is limited research on the perceptions of healthcare providers (HCPs) regarding the challenges that women in Bolivia face when accessing CC secondary prevention. This study therefore explored HCPs’ perceptions of barriers and facilitators for women’s access to CC secondary prevention in Cochabamba, Bolivia.

Methods: Qualitative interviews were conducted with 30 HCPs working in CC secondary prevention, including gynaecologists, general practitioners, nurses, and auxiliary nurses. The interviews were analysed using reflexive thematic analysis. Levesque’s access to healthcare framework informed the study design, and the socio-ecological model was used to discuss the findings across multiple levels.

Results: HCPs perceived numerous barriers and limited facilitators in access to CC secondary prevention at different levels. Barriers at the individual level included information gaps among women. Incentive-based campaigns were used to increase screening, but these did not address the actual treatment barriers or root causes. At the interpersonal–community level, barriers included family-transferred misconceptions, gender norms, and women’s fear of intimate partner violence if attending screening. Facilitators included the use of the Quechua language during healthcare encounters, and material incentives to encourage attendance. Barriers at the organizational–structural level included a lack of clarity regarding which women should be screened and how often, the concentration of centralized cytology services in a single laboratory, unclear responsibilities among staff for sample collection and result delivery, and bureaucratic and administrative barriers that limited access to screening and timely results. These barriers led to long waiting times, generating mistrust and reluctance to engage with CC screening.

Conclusions: HCPs perceive barriers to CC secondary prevention at the individual, community, and organizational levels, including women’s lack of information, family-driven misconceptions, gender norms, unclear screening guidelines, centralized cytology services, and bureaucratic delays that erode trust. Facilitators include the use of Quechua language during care and material incentives to encourage screening attendance; however, these do not address treatment barriers or structural causes.

‘Abortion pills’ (mifepristone and misoprostol) have reshaped the landscape of medication self-managed abortion (SMA), expanding possibilities for feminist accompaniment and redefining what counts as a safe abortion. In contexts marked by criminalisation, abortion pills have enabled SMA to be a safe (even though clandestine) procedure. They have also transformed advocacy narratives, shifting arguments away from preventing death towards affirming sexual and reproductive autonomy. Drawing on narratives produced with eleven feminist collectives in Ecuador and Bolivia, this study follows the trajectories of abortion pills to analyze how these pills both shape—and are shaped by—the abortion landscape and the forms of abortion activism in these countries. We traced how abortion pills changed from being an invisible object crossing borders under the guise of an ulcer medication, to a visible and criminalised substance associated with persecution, to a multiple actor simultaneously embedded in commercial markets and solidarity networks. Within some collectives, the pills were further debated as either reinforcing new normativities, conflicting with ancestral knowledge, or enabling a syncretic articulation of new and ancestral abortion practices. We show that abortion pills gain their most transformative force when integrated into the assemblage of ‘pills + feminist accompaniment’. This assemblage re-signifies the pharmaceuticalisation of abortion. Yet it depends upon the often-exhausting labour of activists, revealing tensions between solidarity and exploitation. We conclude that resistance emerges not from the pills themselves, but from feminist networks that anchor abortion in community, care, and social justice.

Background: Previous research shows that gendered differences in time use unfairly impact women’s career advancement and influence workforce management. Despite a growing body of literature on gendered time use, the topic has not been well documented among specializing medical doctors in sub-Saharan African countries, including Uganda. Objectives: This study was conducted among specialist medical doctors at Makerere University to: (i) analyze gendered differences in time use for paid and unpaid activities and (ii) assess whether parenting influences time use. Methods: The study sample comprised 244 medical doctors pursuing graduate specialist programs in 2024. The data collection, which utilized a self-administered questionnaire, assessed socio-demographic factors and self-reported time spent on paid work, unpaid domestic work, unpaid care for household members, studying, socializing, and leisure activities. Quantile regression analysis, with 95% confidence intervals, was used to compare median differences in reported time use across various activities for men and women. Results: Compared to men, women reported spending more time on unpaid domestic work (2 vs 1 h/day: 95% CI: 0.6, 1.4) and less time on leisure activities (4 vs 7 h/week: 95% CI: −5.3, −0.8). Women with children spent more time on paid work than their male counterparts. Women with children reported spending half a day more on paid work and an additional hour on unpaid domestic work compared to men with children. Conclusion: This gender imbalance in time use could negatively impact the career progression and well-being of female doctors and further reinforce gender inequalities in the medical workforce in Uganda.

Preventing sexual violence is a public health priority given its high prevalence and negative impact on young people’s well-being. This study aims to qualitatively explore the elements that young adults in Spain perceive as influencing their willingness to intervene as bystanders in situations of sexual violence against women. Between 2019 and 2020, we conducted a qualitative study based on 20 semi-structured interviews and four focus group discussions in Spain within the framework of the European project PositivMasc. A total of 49 young men and women participated. We followed Braun and Clarke’s proposal of reflexive thematic analysis. The results of this study describe five elements that are perceived as influencing the willingness to intervene when a situation of sexual violence is witnessed by a bystander: being in a non-party, everyday context; having trust in socio-community assets; holding beliefs that challenge rape culture; emotional distance from the aggressors; and emotional closeness to the victims. The findings are useful when designing new interventions and strengthening existing ones. They can also help in the design of awareness campaigns, strategies, and policies that empower potential bystanders with tools, knowledge, and social support to speak up and act against sexual violence.

Sexual violence (SV) is pervasive on university campuses worldwide, with alarmingly high reported rates in sub-Saharan Africa (SSA). Despite the high reported rates of SV victimization on campuses, existing evidence has not been critically synthesized to give a comprehensive picture of the problem’s extent, common forms, risk factors, and (knowledge about) victims and perpetrators in SSA countries. We aimed to map the existing literature on SV prevalence, types, risk factors, victims, perpetrators, and consequences among university students on campuses in SSA. We included articles focusing on university students from SSA countries published in English or French language from 2014 to 2023. We identified 543 records from nine databases; Academic Search Premier; CINAHL; EMBASE; MEDLINE; PsychINFO; PubMed; Scopus; SocINDEX; and Web of Science, 82 of which met our inclusion criteria. Retrieved articles covered only one-third of the sub-Saharan region, mostly focusing on female students and victims. Prevalence of different forms of SV varied among countries; authors attributed these variations to differences in time frame, forms of SV, how they were defined, and the tools used. Young female students were identified as common victims, while male teachers and students were common perpetrators. We used the socio-ecological model to summarize risk and protective factors associated with SV victimization and listed the health, social, and economic consequences of SV victimization. Despite these consequences, victims rarely seek help, whether from informal sources or authorities. We call for comprehensive studies in SSA that include both genders and focusing on victims and perpetrators, and address service access barriers.

Intimate partner violence is a pervasive injustice that affects one in three women globally. Women experiencing intimate partner violence require immediate, compassionate and nonjudgemental support, not only to prevent negative outcomes and aid in recovery but also to encourage functionality and resilience. However, maintaining equitable relationships during the support-seeking process poses challenges. Formal support can either validate or contribute to re-victimisation, thereby influencing the rectification or reinforcement of injustices. This article explores the experiences of women with disabilities seeking formal support relating to intimate partner violence, utilising an epistemic injustice lens. The focus is on formal support in Sweden, delivered by professionals in healthcare, social services, the police, women's shelters, and the Centre against Violence (centrum mot v & aring;ld). Employing reflexive thematic analysis guided by epistemic injustice as a theoretical framework, the results reveal instances of epistemic injustice. Participants expressed feelings of marginalisation, unheard voices, mistrust and misunderstanding within a formal support system they described as unintelligible and fragmented. Continuous scrutiny of the support-seeking process, coupled with improvements in the capacity of support providers and a re-evaluation of guidelines and procedures, becomes essential to promote inclusivity for women with disabilities, thereby contributing to the achieving of epistemic justice.

Background: In 2014, the Zambian government introduced the Comprehensive Sexuality Education (CSE) framework, decentralising its implementation from the national to the provincial administration. The provincial structures of the Ministries of Health and Education play an important role in providing technical, policy direction and coordination support. However, little research has focused on the role of CSE collaboration at the provincial level.

Objectives: This study sought to explore multisectoral collaboration dynamics influencing the implementation of the CSE framework at the provincial level in Zambia. Methods: This qualitative study involved 29 interviews with diverse stakeholders at the provincial level such as government departments (health, education, etc.), private sector, religious and traditional leaders involved in CSE implementation. We used reflexive thematic analysis, guided by an integrative collaborative governance framework.

Results: The findings were grouped under collaboration dynamics domains: principled engagement, shared motivation, and capacity for joint action. Barriers to principled engagement included provincial structures and their mandate, exclusion or sidelining of certain actors, inadequate financial transparency, and weak formal relations. Shared motivation included collective understanding of the purpose, a supportive policy environment and consensus in adapting the CSE framework. Capacity for joint action efforts included collaborative training of teachers, joint monitoring, and collaborative to address SRHR challenges.

Conclusion: This study highlights challenges limiting meaningful engagement, exclusion of some actors, financial constraints, and weak coordination, which hinder collaboration. There is need for enhancing provincial leadership capacity to effectively coordinate stakeholders through enforcement of transparent resource management, collective planning, implementation and monitoring for effective CSE delivery.

Objectives. To estimate cervical cancer screening (CCS) coverage rates and assess the spatial distribution and clustering between departments and municipalities in Bolivia.

Methods. Standardized CCS coverage rates were calculated using the direct standardization method. The global Moran's I test was used to investigate the existence of spatial autocorrelation of CCS coverage, and the Getis-Ord Gi* was used to identify the spatial clustering of municipalities with high (hot spot) or low (cold spot) coverage.

Results. Overall coverage was low. Around 14% of women aged 20-69 years were screened in Bolivia in 2022. Large geographical inequities in CCS coverage rates were identified both between departments and between municipalities. At the municipal level, CCS showed large differences, ranging from 59% to below 1%. Hot spots were identified in northwestern and southeastern Bolivia; specifically, in Pando, Chuquisaca, and Tarija departments. Cold spots were identified in Beni and Santa Cruz departments.

Conclusions. Bolivia is still a long way from achieving the World Health Organization target of 70% screening coverage. The present results indicate where the screening program must be reinforced to improve the responsiveness of Bolivia's health system to women's reproductive health needs.

Objetivos. Calcular las tasas de cobertura del tamizaje del cáncer cervicouterino y evaluar la distribución espacial y las agrupaciones de departamentos y municipios bolivianos.

Métodos. Se calcularon las tasas estandarizadas de cobertura con el método de estandarización directa. Se utilizó la prueba de la I de Moran global para determinar si había autocorrelación espacial en la cobertura, y se aplicó la prueba de la Gi* de Getis y Ord para encontrar posibles agrupaciones espaciales de municipios donde la cobertura fuese alta o baja.

Resultados. La cobertura general fue baja. En el 2022, en Bolivia se aplicó el tamizaje del cáncer cervicouterino a alrededor del 14% de las mujeres de entre 20 y 69 años. Se observan importantes inequidades geográficas en las tasas de cobertura tanto entre departamentos como entre municipios. A nivel municipal hay grandes diferencias, con valores que van del 59% a menos del 1%. Se observaron zonas de cobertura alta en el nordeste y el sudeste de Bolivia, concretamente en los departamentos de Pando, Chuquisaca y Tarija, mientras que las zonas de cobertura baja se ubicaban en los departamentos de Beni y Santa Cruz.

Conclusiones. Bolivia aún está muy lejos de alcanzar la meta de la Organización Mundial de la Salud de una cobertura del tamizaje del cáncer cervicouterino del 70%. Los presentes resultados indican dónde debe reforzarse el programa de tamizaje para mejorar la capacidad de respuesta del sistema de salud boliviano para atender las necesidades de salud reproductiva de las mujeres.

Objetivos. Estimar as taxas de cobertura do rastreamento do câncer do colo do útero e avaliar aglomerados e a distribuição espacial entre departamentos e municípios na Bolívia.

Métodos. Taxas padronizadas de cobertura do rastreamento do câncer do colo do útero foram calculadas por meio do método de padronização direta. Utilizou-se o índice I de Moran global para investigar a ocorrência de autocorrelação espacial na cobertura do rastreamento e estatística Getis-Ord Gi* para identificar aglomerados espaciais de municípios com cobertura alta (hot spot) ou baixa (cold spot).

Resultados. A cobertura geral foi considerada baixa. Aproximadamente 14% das mulheres de 20 a 69 anos realizaram o rastreamento na Bolívia em 2022. Foram constatadas grandes iniquidades geográficas nas taxas de cobertura do rastreamento do câncer do colo do útero, tanto entre os departamentos como entre os municípios. No nível municipal, o rastreamento apresentou enormes diferenças, variando de 59% a menos de 1%. Foram identificados hot spots no noroeste e no sudeste da Bolívia, especificamente nos departamentos de Chuquisaca, Pando e Tarija. Por outro lado, foram identificados cool spots nos departamentos de Beni e Santa Cruz.Conclusões. A Bolívia ainda está longe de alcançar a meta de 70% de cobertura do rastreamento estabelecida pela Organização Mundial da Saúde. Os resultados indicam áreas onde o programa de rastreamento precisa ser fortalecido para aprimorar a capacidade de resposta do sistema de saúde da Bolívia às necessidades de saúde reprodutiva das mulheres.

Through interviews with 16 social workers, drawing on the concept of “willful subjects”, the aim of this paper is to analyze how social workers working in Swedish municipal social services make sense of, adapt, and/or challenge routine questions about intimate partner violence, and how such routines affect their professional role and agency. We found that participants renegotiated standardized ways of asking by stressing the need to use such questionnaires with care, and stating that the individual judgement and agency of the social worker is paramount. The participants also renegotiated the purpose of asking; while their routine questions about IPV seldom led to a disclosure of ongoing exposure to violence, social workers considered it important to ask because it “opens the door” and signals the possibility of receiving help in the future. We argue that social workers are not necessarily stripped of agency when following standardized protocols and routines, despite increasing efforts to include controlling mechanisms in their everyday practice. However, our results also show that social workers’ legal obligation to report to child protection services, if there are children in the household, limits their room for discretion and how the routine questions about violence are asked and perceived by clients.

Introduction: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents’ access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents’ SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents’ SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents.

Methods: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz’s grounded theory approach was used for the analysis.

Results: We present the core category “being both a grandmother and a CBHW”, which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents’ SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges.

Conclusion: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people’s sexual and reproductive health.