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Adolescence, spanning 10 to 19 years of age, begins with biological changes while transitioning from a social status of a child to an adult. For millions of adolescents in low- and middle-income countries (LMICs), this is a period of exposure to vulnerabilities and risks related to sexual and reproductive health (SRH), compounded by challenges in having their SHR needs met. Globally, adolescent sexual and reproductive ill-health disease burden is concentrated in LMICs, with sexually transmitted infections and complications from pregnancy and childbirth accounting for the majority of the burden. Adolescents around the world are using their voices to champion access to high-quality, comprehensive SRH information and services. Thus, it is imperative that adolescents’ SRH and rights be reinforced and that investments in services be prioritized.

Nearly 80% of the world’s population lives in low- and middle-income countries (LMICs) and these regions bear the greatest burden of maternal, neonatal, and child mortality, with most of the deaths occurring at home. Much of global maternal and child mortality is attributable to easily preventable and treatable conditions. However, the challenge lies in reaching the most vulnerable communities, especially the rural populations, making it imperative that maternal, newborn, and child health (MNCH) interventions focus on communities in tandem with facility-based strategies. There is widespread consensus that delivering effective primary health care (PHC) interventions through the continuum of care, starting from pregnancy to delivery and then to the newborn, infant, and the young child, is an integral component of health strategies in high-, middle- and low-income settings. Despite gaps in research, several effective community-based PHC approaches have been proven to impact MNCH positively. Implementation of these strategies is needed at scale in LMICs and in partnership with all stakeholders including the public and private sector. Community-based PHC, operating on the principles of community engagement and community mobilization, is now more critical than ever. Further robust studies are needed to evaluate certain strategies of community-based PHC and their impact on maternal and child health outcomes, such as the use of mobile technology and social franchises. Recognition of community health workers (CHWs) as a formal cadre and the integration of community-based health services within PHC are vital in strengthening efforts to impact maternal, neonatal, and child health outcomes positively. However, despite the importance of community-based PHC for MNCH in LMICs, the existence of a strong health system and skilled workforce is central to achieving positive health outcomes in these regions.

Abortion is a common part of people’s reproductive lives, regardless of where they live in the world. When using World Health Organization-recommended methods of either surgical or medical abortion, procedures are very safe and effective, and providers do not need a lot of information or testing to provide quality services. Both medical and surgical methods may be used to induce or to treat incomplete abortion. Although both methods are safe and effective, they have different characteristics and acceptability; therefore, clients should be given the choice of method in settings where it is possible. Service delivery can include provision of surgical and medical abortion services by many cadres of providers, from nurses and midwives to physicians. Most people (generally around 90%) seek induced abortion before 12 weeks’ gestation, during which time medical abortion can be safely provided either through an in-person clinical encounter or through telemedicine, and there is emerging evidence of safe over-the-counter-like use. Postabortion care includes the timely management of an unsafe or spontaneous abortion (spontaneous loss of pregnancy) that has happened or is in progress; it has been a global strategy to reduce the morbidity and mortality related to less safe abortions. For all people having an abortion, postabortion care includes information and voluntary provision of postabortion contraception or other desired reproductive health services.

Contraceptive technology refers to tools that are used to delay or prevent pregnancy. Modern contraceptive technology encompasses female or male sterilization, intrauterine devices, contraceptive implants, contraceptive pills, contraceptive patches, intravaginal rings, diaphragms, external or internal condoms, emergency contraception, and certain fertility awareness–based methods. Duration of these methods’ effects varies from permanent and irreversible to long-lasting and reversible to short term with day-to-day reversibility. The efficacy of modern contraceptive technologies at preventing pregnancy ranges between 76% and 99.95% during the first year of typical use. Mechanisms of action vary from physically impeding meeting of sperm and oocyte to use of exogenous reproductive hormones to alter fertility. Contraceptive counseling for the selection of a method should adopt a shared decision-making framework and can consider advantages, disadvantages, contraindications, and side effects of a method to align with a patient’s contraceptive use goals. Certain clinical contexts, such as post-abortion, postpartum, adolescent patients, and patients with elevated body mass index have contraceptive nuances that are important to consider. Finally, contraceptive technology has many non-contraceptive benefits that provide additional indications for their use.

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by impairments in social interaction and communication and by the presence of restrictive, repetitive behavior. Attention deficit hyperactivity disorder (ADHD) is another common lifelong neurodevelopmental disorder characterized by three major presentations: predominantly hyperactive/impulsive, predominantly inattentive, and combined. Although ASD and ADHD are different clinical diagnoses, they share various common characteristics, including male dominance, early childhood onset, links to prenatal and perinatal factors, common comorbidity for each other, and, often, persistence into adulthood. They also have both unique and shared risk factors, which originate in early life and have lifelong implications on the affected individuals and families and society. While genetic factors contribute to ASD and ADHD risk, the environmental contribution to ASD and ADHD has been recognized as having potentially equal importance, which raises the hope for early prevention and intervention. Maternal folate levels, maternal metabolic syndrome, and metabolic biomarkers have been associated with the risk of childhood ASD; while maternal high-density lipoprotein, maternal psychosocial stress, and in utero exposure to opioids have been associated with the risk of childhood ADHD. As for shared factors, male sex, preterm birth, placental pathology, and early life exposure to acetaminophen have been associated with both ASD and ADHD. The high rate of comorbidity of ASD and ADHD and their many shared early life risk factors suggest that early identification and intervention of common early life risk factors may be cost-effective to lower the risk of both conditions. Efforts to improve maternal preconception, prenatal, and perinatal health will not only help reduce adverse reproductive and birth outcomes but will also help mitigate the risk of ASD and ADHD associated with those adverse early life events.

The vast majority of births in the world occur within marriages or stable partnerships. Yet family planning programs have largely ignored the male partner. One justification for this nearly exclusive focus on women has been that almost all of the modern contraceptive methods are female-oriented. In contrast, studies of fertility preferences within couples that included a later follow-up have shown that men’s fertility preferences are important for predicting subsequent births. Interspousal communication can be key to resolving differences in desired family size and for promoting open contraceptive use. Experimental studies with couples on family planning education and/or counseling show higher contraceptive prevalence or continuation in the couples groups than in the women-only groups, though the differences are not always significant statistically. Other intervention studies have varying designs and mixed results. The purpose of this systematic review is to summarize the research findings on interventions with couples on reproductive health from experimental and pre–post observational studies. An important conclusion is that couples education and counseling are critical components for involving male partners. There is a need for systematic research on couples using a standardized intervention and fixed follow-up times and including analyses of cost-effectiveness.

Fetal death refers to the death of a post-embryonic product of conception while in utero or during childbirth, and it is one of the most distressing events faced by women and families. Birth following spontaneous fetal death is termed “miscarriage” if it occurs early in gestation, and “stillbirth,” if it occurs beyond the point of viability. There are substantial between-country differences in the criteria used for reporting stillbirths and these differences compromise international comparisons of stillbirth rates. In high-income countries, a majority of fetal deaths occur due to genetic causes, fetal infection, or other pregnancy complications. Congenital anomalies, placental insufficiency, and/or intrauterine growth restriction are frequent antecedents of fetal death. Maternal risk factors include advanced maternal age, high body mass index, smoking and substance use during pregnancy, prior stillbirth, chronic morbidity, and multifetal pregnancy. Disparities in education and socioeconomic status and other factors influencing maternal health also contribute to elevated rates of stillbirth among vulnerable women.

According to 2015–2019 data, there are 121 million unintended pregnancies each year globally. One hundred eleven million of these occur in low- and middle-income countries. Of all unintended pregnancies, 61%, or about 73 million pregnancies, end in abortions annually, at the rate of 39 abortions per 1,000 women of reproductive age. About half the abortions, or 35 million of them, are unsafe, contributing to the 299,000 maternal deaths each year. These, in turn, have implications for the realization of almost every one of the 17 United Nations Sustainable Development Goals, specifically ensuring good health and well-being, achieving gender equity, and ending poverty. Abortions occur in every country irrespective of income level or the legal status of abortion. From 1990 to 2019, there has been a greater increase in the proportion of pregnancies ending in abortions in countries where abortion is restricted compared with countries where abortion is broadly legal. A growing proportion of these abortions are medication abortions, incorporating the use of mifepristone or misoprostol or both. The availability of this becomes even more important in areas where policy or infrastructure or both are more restrictive for providing safe, legal abortions. Providing quality, women-centered, comprehensive abortion care that is equitably accessible hence becomes imperative to addressing a woman’s ability to access appropriate medical care for her reproductive needs. Making this amenable to a digital platform overcomes even more barriers, be they socioeconomic or policy-driven. Fortunately, recent research and evidence support this, hence broadening the availability of safe abortion care into areas and demographics that remained precluded from the availability of comprehensive reproductive health care. Targeted progress and strengthened commitments are needed to further this penetration and provide access to compassionate, safe, and quality care for abortion and family planning.

Gender and reproductive health empowerment are central concepts for understanding and improving population health and well-being. Beginning in the 1990s, global platforms, including the United Nations, began recognizing gender-based inequities, including violence against women and lack of women’s participation in education and the economy, as social determinants of health. Since the 1990s there has been growing international interest in the concept of empowerment as a means for understanding the mechanisms that drive outcomes related to health and development. Although several definitions of empowerment have evolved over the past 30 years, the pivotal work of Dr. Naila Kabeer has grounded many interpretations of women’s empowerment as a process by which a woman has the individual capacity and freedom to act on her own choices in life. To date, the lack of comparable empowerment definitions remains a major hindrance to conducting comprehensive research that links empowerment to health outcomes. Additionally, while most recognize empowerment as a multidimensional process, the majority of measures used for examining this concept have been unidimensional (focused on agency, self-efficacy, household decision-making, etc.), thereby limiting the understanding of empowerment across populations, geographies, and contexts. Subsequent framing of women’s empowerment has focused specifically on sexual and reproductive empowerment, recognizing that women may be empowered in certain realms (e.g., economic), but not in others (e.g., autonomy in contraceptive decisions). Developments in the conceptualization of reproductive empowerment since 2015 have paved the way for improved measurement and exploration of this concept, yet gaps in research remain.

Gender-based violence (GBV) is a significant global public health and human rights problem, predominantly affecting women and girls worldwide across various age groups. While GBV manifests in various forms, intimate partner violence and domestic violence are the two most common forms that are widely studied and discussed in the research and policymaking processes due to the disturbingly high prevalence. The World Health Organization (WHO) estimated that 736 million women and girls globally are affected by IPV and non-partner sexual violence, even though the statistics vary across different regions . While the knowledge in understanding the prevalence and patterns of GBV has been improved over time, gathering reliable data on certain forms of GBV like femicide, rape, early marriage, sexual violence in situations of armed conflict, and trafficking in women and girls remains challenging . This data limitation stems primarily from socio-cultural norms that stigmatize the experiences of GBV survivors and a male-dominated culture that obstructs survivors from reporting and seeking help. The data gap is more notable for male survivors, despite studies showing that men and boys often fall victim to various forms of GBV, particularly in armed conflicts. GBV in any form against any gender produces immediate, short-term, and lasting physical, mental, and social consequences for survivors, their families, and communities. A swift and comprehensive response to GBV can mitigate specific health risks, such as HIV/AIDS transmission and unintended pregnancies, significantly reducing the public health burden. However, survivors often face immense challenges in accessing appropriate care due to limited availability and accessibility. The barriers to seeking care are compounded by negative societal perceptions of GBV survivors and limited legal protection mechanisms. Unequal gender norms and discriminatory practices against women and girls in most societies are the fundamental cause of GBV while several intersecting factors like age, ethnicity, education, social beliefs, and cultural norms significantly influence the manifestation of GBV. Eliminating GBV is a complex process that requires a multidimensional approach at the individual, community, and societal levels. The most effective strategies involve transforming social norms, reforming laws, and empowering women through awareness-raising and state policies. However, resistance stemming from deeply embedded male-dominated cultures and a lack of political will among state actors often pose obstacles to effective prevention efforts. Research plays a crucial role and dedicating resources to fill knowledge gaps and evaluating ongoing practices will enhance the understanding of effective measures for preventing and responding to GBV.

Induced abortion is a common reproductive experience, with more than 73 million abortions occurring each year globally. Worldwide, the annual abortion incidence decreased in the 1990s and the early decades of the 21st century, but this decline has been driven by high-resource settings, whereas abortion rates in low- and middle-resource countries have remained stable. Induced abortion is a very safe procedure when performed according to World Health Organization guidelines; however, legal restrictions, stigma, cost, lack of resources, and poor health system accountability limit the availability, accessibility, and use of quality abortion care services. Even as women’s use of safer self-managed medication abortion options becomes more common in some parts of the world, 45% of all abortions annually are unsafe, nearly all of which occur in low- and middle-resource settings, where unsafe abortion remains a primary cause of maternal death. Beyond country-level legal and health care system factors, significant disparities exist in women’s reliance on unsafe abortion. Even among women who receive a safe abortion, quality of care is often poor. Yet abortion’s precarious status as a health care service and its clandestine practice have precluded a systematic focus on quality monitoring and evaluation of service inputs. Improving abortion and postabortion care quality is essential to meeting this reproductive health need, as are efforts to prevent abortion-related mortality and morbidity more broadly. This requires a three-tier approach: primary prevention to reduce unintended pregnancy, secondary prevention to make abortion procedures safer, and tertiary prevention to reduce the negative sequelae of unsafe abortion procedures. Strategies include two complementary approaches: vulnerability reduction and harm reduction, the first focusing on the root causes of unsafe abortion by addressing the determinants of unwanted pregnancy and clandestine abortion, while the latter addresses the harmful consequences of clandestine abortion. Political commitments to extend service coverage of abortion and postabortion care need to be implemented through actions that build the public health system’s capacity. Beyond the model of receiving care exclusively in clinical settings, models of guided self-managed abortion are expanding the capacity of individuals to take evidence-based actions to terminate their pregnancies safely and without the threat of judgment. Research has strived to keep up with the changes in the abortion care landscape, but there remains a continuing need to improve methodologies to generate robust evidence to identify and address inequities in abortion care and its health consequences in a diversified landscape. Doing so will provide information for stakeholders to take actions toward a new era of health care reforms that repositions abortion as an integral component of sexual and reproductive health care.

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.