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At the end of 2016, there were approximately 36.7 million people living with HIV worldwide with 1.6 million people being newly infected. In the same year, 1 million people died from HIV-related causes globally. The vast prevalence of HIV calls for an urgent need to develop and implement prevention programs aimed at reducing risk behaviors. Bronfenbrenner’s socio-ecological model provides an organizing framework to discuss HIV prevention interventions implemented at the individual, relational, community, and societal level. Historically, many interventions in the field of public health have targeted the individual level. Individual-level interventions promote behavior change by enhancing HIV knowledge, attitudes, and beliefs and by motivating the adoption of preventative behaviors. Relational-level interventions focus on behavior change by using peers, partners, or family members to encourage HIV-preventative practices. At the community-level, prevention interventions aim to reduce HIV vulnerability by changing HIV-risk behaviors within schools, workplaces, or neighborhoods. Lastly, societal interventions attempt to change policies and laws to enable HIV-preventative practices. While previous interventions implemented in each of these domains have proven to be effective, a multipronged approach to HIV prevention is needed such that it tackles the complex interplay between the individual and their social and physical environment. Ideally, a multipronged intervention strategy would consist of interventions at different levels that complement each other to synergistically reinforce risk reduction while simultaneously creating an environment that promotes behavior change. Multilevel interventions provide a promising avenue for researchers and program developers to consider all levels of influences on an individual’s behavior and design a comprehensive HIV risk-reduction program.

Male reproductive function entails complex processes, involving coordinated interactions between molecular structures within the gonadal and hormonal pathways, tightly regulated by the hypothalamic–pituitary gonadal axis. Studies in men and animal models continue to unravel these processes from embryonic urogenital development to gonadal and urogenital ducts function. The hypothalamic decapeptide gonadotropin-releasing hormone is released into the hypophyseal portal circulation in a pulsatile fashion. It acts on the gonadotropes to produce the gonadotropins, the main trophic hormones acting on the testis to regulate sperm production. This endocrine control is complemented by paracrine and autocrine regulation arising from the testis, where germ cells originate, modulated by growth factors and local regulators arising within the testis. The process of spermatogenesis, originating in seminiferous tubules, is characterized by stem cell proliferation and differentiation, meiotic divisions, expression of transcriptional regulators, through to morphological changes which include cytoplasm reorganization and flagellum development. Metabolic processes and signal transduction pathways facilitate the functional motion and transport of sperm to the site of fertilization. The normal sperm structure or morphology acquired during spermatogenesis, epididymal maturation, sperm capacitation including motility, and subsequent acrosome reaction are all critical events in the acquisition of sperm fertilizing ability. Generation of the male gamete is assured through adequate gonadal function, involving complex differentiation processes and regulation, during spermiogenesis and spermatogenesis. Sperm functional changes are acquired during epididymal transit, and functional motion is maintained in the female reproductive tract, involving activation of signaling processes and transduction pathways. Infertility can arise in the male, from spermatogenic failure, sperm functional quality, obstruction and other factors, but causes remain unknown in a large proportion of affected men. Semen analysis, complemented by the clinical picture, remains the mainstay of male infertility investigation. Assisted reproductive technology has proved useful in instances where the cause is not treatable. Complications from sexually transmitted infections could lead to male infertility, by impairing sperm quality, production, or transport through the reproductive tract. Male fecundity denotes the biological capacity of men to reproduce, based on ability to ejaculate normal sperm. Lifestyle, environmental, and endocrine disruptors have been implicated in reduced male fecundity. Interactions between vascular, neurological, hormonal, and psychological factors confer normal sexual function in men. Nocturnal erections begin in early puberty, occurring with REM sleep. Sexual health is an integral part of sexual and reproductive health, while sexual dysfunction, in various forms, is also experienced by some men. Methods of contraception available to men are few, and underused. They include condoms and vasectomy. Enhanced knowledge of male reproductive function and underlying physiological mechanisms, including sperm transit to fertilization, can be catalytic in improvements in assisted reproductive technologies, male infertility diagnosis and treatment, and development of contraceptives for men. The article reviews the processes associated with male reproductive function, dysfunction, physiological processes and infertility, fecundity, approaches to male contraception, and sexual health. It further alludes to knowledge gaps, with a view to spur further research impetus towards advancing sexual and reproductive health in the human male.

Malnutrition is caused by consuming a diet with either too little and/or too much of one or more nutrients, such that the body malfunctions. These nutrients can be the macronutrients, including proteins, carbohydrates, and fats that provide the body with its building blocks and energy, or the micronutrients including vitamins and minerals, that help the body to function. Infectious diseases, such as diarrhea, can also cause malnutrition through decreased nutrient absorption, decreased intake of food, increased metabolic requirements, and direct nutrient loss. A double burden of malnutrition (both overnutrition and undernutrition) often occurs across the life course of individuals and can also coexist in the same communities and even the same households. While about a quarter of the world’s children are stunted, due to both maternal and young child undernutrition, overweight and obesity affects about one in three adults and one in ten children. Anemia, most commonly due to iron deficiency, is also affecting about a third of women of reproductive age and almost half of preschool children. Around 90% of nations have a serious burden of either two or three of these different forms of malnutrition. Malnutrition is one of the principal and growing causes of global disease and mortality, affecting at least half of the world’s inhabitants. Programs for tackling maternal and child undernutrition have gained impetus in the last decade with a consensus developing around a package of effective interventions. The nutrition-specific interventions, mostly delivered through the health sector, are directed at immediate levels of causality, while nutrition-sensitive interventions, directed at the underlying and basic levels of causality are delivered through other sectors such as agriculture, education, social welfare, as well as water and sanitation. Less consensus exists around the interventions needed to reduce overnutrition and the associated non-communicable diseases (NCDs), including diabetes, high blood pressure, and coronary heart disease. Prevention is certainly better than cure, however, and creating enabling environments for healthy food choices seems to be the most promising approach. Achieving “healthy diets for all,” by reducing consumption of meat and ultra-processed foods, as well as increasing consumption of fruit and vegetables, would help control rising rates of obesity and reduce NCD mortality. Adopting such healthy diets would also greatly contribute to reducing greenhouse gas emissions: the agriculture sector is responsible for producing a third of emissions, and a reduction on livestock farming would contribute to reducing global warming. Public health nutrition capacity to manage such nutrition programs is still widely lacking, however, and much still needs to be done to improve these programs and their governance.

Maternal health and well-being refers to the physical, psychological, and emotional well-being of women during pregnancy, childbirth, and the postnatal period, as well as the absence of any morbidities or death either due to pregnancy or its management. Despite making a comparatively late appearance on the international global policy agenda, maternal health and well-being has progressively become a global health policy priority following Deborah Maine’s revolutionary article on maternal mortality. Consequently, key international policy events from Alma Ata to the International Conference on Population and Development events, through the Millennium Development Goals to the Sustainable Development Goals (SDGs) in the last decade have consecrated women’s inalienable right to safe and respectful health services. Also, the growing focus on rights-based care against the backdrop of the need to ensure equity in all communities worldwide has led to an evolution in policy focus, calling on health systems to not only protect women and girls from preventable deaths but to also empower them to thrive, all while recognizing their unique role is ensuring the positive transformation of the communities in which they live. This increasing policy attention has contributed to a disproportionate yet marked reduction in global maternal mortality and morbidity statistics over the last 30 years. However, if the world is to achieve its 2030 SDGs women’s health and gender equality agendas, it is important to recognize that the broad concept of women’s health cannot be limited to the rather narrow window of pregnancy, childbirth, and the postpartum period. While there are huge gaps in all resource-type settings in promoting and protecting women’s agency and autonomy, the fact remains that in addition to ensuring the availability of and access to high-quality maternal health services, women’s health outcomes are inextricably linked to their decision-making power on key issues such as when to become sexually active, the use of contraception, whether or not they want to achieve pregnancy and childbirth, and access to safe abortion care services. Additionally, the growing burden of noncommunicable diseases and the increasing occurrence of worldwide pandemics are providing novel challenges to the health and well-being of the world’s most vulnerable women and girls, thus creating the need to ensure resilient health systems that are considerate of the rights and wishes of the world’s women and girls.

Menstruation refers to the periodic flow of blood from the uterus exiting the body through the vagina. Menarche (the first menstruation) signals the onset of reproductive maturity in females and is a result of the shedding of the wall of the uterus that occurs when there is no implantation of a fertilized ovum. The menstrual cycle commences on the first day of menstrual blood flow until the day before the next menstrual blood flow, and the cycle lasts an average of 28 days. Menstrual health refers to the state of complete physical, mental, and social well-being related to the menstrual cycle and is integral to both human rights to dignity and reproductive health as well as achieving multiple Sustainable Development Goals. The concept of menstrual health as a holistic framework encompasses the factors that contribute to the menstrual experiences of girls, women, and all people who menstruate—as well as the broader impacts of those menstrual experiences on well-being. The menstrual cycle has historically been neglected in global health discussions. The inaccessibility and inadequacy of information, support, and resources necessary for experiencing optimal menstrual health can have consequences for the physical health, well-being, social participation, education, and economic opportunities of individuals who menstruate. Timely provision of accurate, age-appropriate information about the menstrual cycle and the practical aspects of experiencing menstrual periods is important for girls who will soon reach menarche—and also for the wider population to foster appropriate social support and inclusive environments that accommodate the needs of those who menstruate. Such needs include access to effective and affordable menstrual materials and appropriate sanitation facilities with waste disposal mechanisms, timely diagnosis and treatment for menstrual discomforts and disorders, and freedom from menstrual stigma. Promoting menstrual health thus requires comprehensive efforts to promote menstrual health education, address pervasive menstrual stigma, challenge social norms that perpetuate discrimination based on menstruation, and improve access to necessary resources for addressing menstrual needs.

Monitoring and evaluation (M&E) can be defined as the systematic collection, analysis, and use of data to answer questions about program performance and achievements. An M&E system encompasses all the activities related to setting up, collecting, reporting, and using program information. A robust, well-functioning M&E system can provide program stakeholders with the information necessary to carry out a responsive and successful program intervention and is therefore a critical tool for program management. There are many tools and techniques needed for successful M&E of sexual and reproductive health (SRH) programs. These include frameworks to visually depict the organization of the program, its context and goals, and the logic of its M&E system. Essential practices of M&E also include continuous stakeholder engagement, the development of indicators to measure program activities and outcomes, the collection and use of data to calculate the indicators, and the design and implementation of evaluation research to assess the benefits of the program. Over time, language around “M&E” has evolved, and multiple variations of the phrase are in use, including “MEL” (monitoring, evaluation, and learning), “MER” (monitoring, evaluation, and reporting), and “MERL” (monitoring, evaluation, research, and learning), to name but a few. These terms bring to the forefront a particular emphasis of the M&E system, with an apparent trend toward the use of “MEL” to emphasize the importance of organizational learning. Despite this trend, “M&E” continues to be the most widely known and understood phrase and implicitly includes activities such as learning, research, and reporting within a robust system.

As under-5 mortality declines globally, newborn or neonatal mortality is becoming increasingly important. Depending on measurement and empirical data sources, calculation of the magnitude and trend of all-cause and cause-specific neonatal mortality ranges from direct methods to model-based estimates. From 1990 to 2019, the global neonatal mortality rate decreased by 52%, though wide regional variations persist, with sub-Saharan Africa (SSA) consistently experiencing the highest neonatal mortality rates, followed by Southern Asia, accounting for 79% of the 2.4 million total newborn deaths in 2019. Globally, most deaths in 2019 are due to preterm birth complications (36%), intrapartum-related events (24%), congenital abnormalities (10%), pneumonia (8%), and sepsis (7%). Since 2000, in low- and middle-income regions like Central Asia and South Asia and SSA, most deaths were avoided through declines in intrapartum-related events (3.4% and 1.9% AARR [average annual rate of reduction from 2000 to 2019], respectively) and preterm birth complications (2.9% and 1.9% AARR, respectively); whereas high-income regions like Europe, Northern America, Eastern Asia and South-Eastern Asia were more rapidly able to reduce deaths due to congenital abnormalities (2.8% and 3.2% AARR, respectively). More investment is urgently required to improve data collection and data quality, as well as to leverage supporting empirical data with statistical modeling to improve the validity of neonatal mortality and cause-of-death estimates.

Obstetric fistula (OF) is a condition that remains prevalent in non-industrialized nations, mainly in sub-Saharan Africa and Southeast Asia where proper and timely obstetrical care is inaccessible, unavailable, or inadequate. The reasons for the delay vary from country to country where poverty remains a common thread, and understanding the many factors leading to the development of OF is critical in preventing this scourge that has been all but eliminated in industrialized nations. Preventive measures can be effective when developed in conjunction with local resources and expertise and should include patient education and empowerment in addition to educating and equipping healthcare providers. In the absence of such measures, patients develop an « obstructed labor injury complex » involving the genital, urinary, and gastrointestinal tracts. Many troublesome health consequences arise from this complex, including skin lesions from the caustic effects of urine, endocrine abnormalities such as amenorrhea and infertility, neuropsychological consequences such as depression and suicide, and musculoskeletal impairments such as foot drop and contractures. Globally, evidence-based interventions are needed to address the debilitating and persistent medical, psychological, and social effects of this condition on its sufferers. While surgery offers the amelioration of symptoms, many patients may not have access to such care due to lack of funds, knowledge of surgical options, or availability of surgical facility. Even after successful repair of the fistula, patients may still suffer from persistent incontinence, stigma, and socio-economic hardship requiring special programs for support, rehabilitation, and reintegration. Additionally, the patients who are deemed inoperable require special counseling and care. Consensus is needed on standardizing care and outcome measures to improve the quality of care and to evaluate programs directed toward prevention that will render this condition obsolete.

Understanding pregnancy and fertility intentions is critical to project population accurately, to predict risk, and to intervene for maternal and child well-being outcomes. Although both pregnancy and fertility intentions refer to reproductive intentions, pregnancy intentions are typically a measure of retrospective reports about a specific pregnancy, whereas fertility intentions are typically a measure of assessing plans for future childbearing. Contemporary childbearing theories incorporate social-psychological and life course considerations. The measurement of intentions has become more nuanced, moving beyond a dichotomous measure of intended versus unintended, but additional work on measurement is needed on ambivalence, in particular. Despite progress in understanding pregnancy and fertility intentions and their predictors and consequences, unintended pregnancy rates remain high in the United States at the same time that the fertility gap between intentions and achieved fertility continues to widen globally.

The focus on non-sexually transmitted infections during pregnancy is relevant, as they are one of the main causes of fetal and neonatal morbidity and mortality in many regions of the world, especially in low- and middle-income countries, respecting no national boundaries. While their possible vertical transmission may lead to adverse pregnancy outcomes, congenital rubella syndrome, measles, mumps, varicella, influenza, Zika virus, dengue, malaria, and toxoplasmosis are all preventable by measures such as vector control or improvement in sanitation, education, and socioeconomic status. Some are likewise preventable by specific vaccines already available, which can be administered in the first years of childhood. A package for intervention also includes adequate preconception care, routine antenatal screening, diagnosis, and treatment during pregnancy. Non-sexually transmitted diseases during pregnancy have different worldwide distributions and occasionally display as emerging or re-emerging diseases. Their epidemiological and clinical aspects, as well as evidence-based prevention and control measures, are relevant to settings with ongoing transmission or those about to be in vulnerable situations. Non-sexually transmitted infections are major public and global health concerns as potential causes of epidemics or pandemics, with numerous social, economic, and societal impacts..

Preterm birth is a significant global public health issue. It is defined by the World Health Organization as infants born alive before 37 completed weeks of gestation. The preterm birth rate varies significantly across countries and regions. Globally, an estimated 13.4 million babies were born preterm in 2020 (i.e., 1 in 10 babies worldwide was preterm birth). It is the leading cause of under-5 child mortality worldwide, and preterm infants are particularly vulnerable to respiratory complications, feeding difficulty, poor body temperature regulation, and high risk of infection. Both genetic and nongenetic factors (exposome factors) contribute to the risk of preterm birth. Social and behavioral factors, medical and pregnancy conditions, and environmental exposures are common nongenetic risk factors for preterm birth. Individuals from certain ethnic and racial groups, in low- and middle-income countries, or with a low socioeconomic status are at an increased risk of having preterm birth, and social determinants of health are the root causes of these factors. Existing pregnancy complications, history of preterm birth, and other medical conditions are also common risk factors. Environmental exposures such as air pollution, climate change, and endocrine-disrupting chemicals have been increasingly realized as potential risk factors for preterm birth. Various pathological events in different feto-maternal systems have been reported to be involved in the development of preterm birth. Immunopathogenesis plays a pivotal role, and both pathogenic and nonpathogenic inflammation can induce preterm birth. Oxidative stress, decidual hemorrhage and vascular lesions, uterine overdistension, and cervical insufficiency have all been proposed to contribute to the pathophysiology of preterm birth. Prevention strategies for preterm birth include primary prevention aimed at the modifiable risk factors at the individual and societal levels and therapeutic approaches using pharmaceuticals and mechanical interventions, such as progesterone and cervical cerclage. A comprehensive approach is still needed to reduce the global disease burden of preterm birth.

The future of sub-Saharan Africa depends on the health of young people (10–24 years) who form about one-third of the region’s population. This large population of young people is a potential asset for social-economic development if appropriate investments and social empowerment can be provided. Despite the vast opportunities, young people are faced with enormous social, economic, and health challenges. Young people’s health increasingly remains important especially with the use and misuse of narcotics (drugs and alcohol) a key risk factor for risky sexual behaviors (RSBs). RSBs are defined as behaviors that increase one’s risk of contracting sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) and unintended pregnancies. RSBs include multiple sex partners, sex without a condom, alcohol use with sex, sex initiation before age 15, nonuse of modern contraceptives, and early marriage (before age 18 years). RSBs are reportedly influenced by a number of factors including lack of access to accurate, customized HIV information and prevention services, socioeconomic reasons, lack of parental control, peer pressure, and lack of youth-friendly recreational facilities. The consequences or impact of RSB, especially among the adolescents and young people, include poor health (STIs including HIV/AIDS, unintended pregnancies, unsafe abortions, maternal deaths, and mental health such as psychological distress), and negative social and economic challenges (nonenrollment and nonretention in school and early child marriage). Understanding the trends in RSBs can provide insights in how well available interventions and policies have minimized their consequences among adolescents, and lay a basis to further develop more innovative and effective strategies especially in low-income countries.

Central to the survival of any species is the ability to procreate. In most cases, procreation is sexual, involving a process that ensures appropriate and timed contact between the male and female gametes. Successful human reproduction is premised on sexual intercourse occurring at a time when there is a receptive endometrium as well as an ovum ready for fertilization by spermatozoa. This time window of the menstrual cycle known as the fertile or fecund window is poorly defined and highly variable from one individual to another. Furthermore, while spermatogenesis is a continuous process, the impact of too frequent intercourse (defined as that occurring more than every 2 to 3 days) on fertilization has often been thought to be associated with a decreased fertilization potential of spermatozoa. Current evidence challenges previously held views on the fertile window and how it is determined, the timing of intercourse and how it is related to conception and miscarriages, the length of the luteal phase, and the precise time period during which the chances of fertilization are highest in any given menstrual cycle. The ability of spermatozoa to survive in the female genital tract for 5 days means fertilization can occur up to 5 days from sexual intercourse. During each menstrual cycle, there is a window of 5 to 6 days for fertilization to occur, and this period is defined not by the length of the cycle but by the timing of ovulation, with the chances of fertilization highest with intercourse occurring 1 to 2 days before ovulation.

Social and behavior change communication (SBCC) is a core public health strategy not just for interventions designed to prevent, control, and treat disease but also for addressing the social determinants of health. Quality SBCC interventions are based on some common design, implementation, and evaluation best practices. The evidence base for using SBCC for sexual and reproductive health (SRH) includes, among other programs, family planning, maternal and neonatal health, and HIV/AIDS. Three global SBCC interventions—one on each of these topics—are presented as exemplars of best practices in public health communication programs designed to improve individual health behaviors and enable social change. These SBCC programs employed cross-cutting approaches covering different levels of the social-ecological model while tackling multiple related health issues. While emphasizing individual roles and responsibilities, recognizing the importance of the cultural, social, and political context within which individuals live and work allowed these interventions to address social and gender norms. All three were theory-based and evidence-driven. They applied constructs from social and behavior change (SBC) theories to model causal pathways and stages or steps of behavior and community-level change. In addition, they relied on comprehensive, mixed-methods research throughout the project cycle. Other best practices included intersectoral collaboration and steps to ensure scale-up and sustainability.

Research in diverse fields has examined how social and gender norms, broadly defined as informal rules of acceptable behavior in a given group or society, may influence sexual and reproductive health outcomes. One set of conceptual and empirical approaches has focused on perceptions of how commonly others perform a behavior and the extent to which others support or approve of the behavior. Another set of approaches has focused on how social norms emerge from structures of gender and power that characterize the social institutions within which individuals are embedded. Interventions intended to improve sexual and reproductive health outcomes by shifting social and gender norms have been applied across a wide range of populations and settings and to a diverse set of behaviors, including female genital mutilation/cutting, the use of modern contraceptive methods, and behavioral risk reduction for HIV. Norms-based intervention strategies have been implemented at multiple socioecological levels and have taken a variety of forms, including leveraging the influence of prominent individuals, using community activities or mass media to shift attitudes, and introducing legislation or policies that facilitate the changing of social norms. Recent advances in social and gender norms scholarship include the integration of previously disparate conceptual and empirical approaches into a unified multilevel framework. Although challenges remain in measuring social and gender norms and studying their impacts on sexual and reproductive health-related behaviors across cultures, the research will continue to shape policies and programs that impact sexual and reproductive health globally.

Women in all countries use substances, and for some women, such use continues during pregnancy. When substance use impairs life functioning and becomes a use disorder, regardless of the type of substance, effective treatments are available (e.g., medication to treat opioid and alcohol use disorders and behavioral approaches to treat tobacco, stimulant, and other substances). In two very different cultural contexts, the United States and Afghanistan, pregnant women face common issues when using substances and seeking and/or receiving help for problem substance use. In both countries, and around the world, many women who have substance use disorders during and after pregnancy face tremendous stigma and discrimination. Yet, similarly, in both the United States and Afghanistan, when women receive integrated medical and behavioral health care for their substance use disorder, they and their children have more optimized opportunities for healthy life outcomes.