The novel coronavirus disease outbreak was first declared in China in December 2019, and WHO declared the pandemic on 11 March 2020. A fast-rising number of confirmed cases has been observed in all continents, with Europe at the epicentre of the outbreak at this moment. Sexual and reproductive health (SRH) and rights is a significant public health issue during the epidemics. The novel coronavirus (SARS-CoV-2) is new to humans, and only limited scientific evidence is available to identify the impact of the disease COVID-19 on SRH, including clinical presentation and outcomes of the infection during pregnancy, or for persons with STI/HIV-related immunosuppression. Beyond the clinical scope of SRH, we should not neglect the impacts at the health system level and disruptions or interruptions in regular provision of SRH services, such as preand postnatal checks, safe abortion, contraception, HIV/AIDS and sexually transmitted infections. Furthermore, other aspects merit attention such as the potential increase of gender-based violence and domestic abuse, and effects of stigma and discrimination associated with COVID-19 and their effects on SRH clients and health care providers. Therefore, there is an urgent need for the scientific community to generate sound clinical, epidemiological, and psycho-social behavioral links between COVID-19 and SRH and rights outcomes.

Inclusion of pregnant women in COVID-19 clinical trials would allow evaluation of effective therapies that might improve maternal health, pregnancy, and birth outcomes, and avoid the delay of developing treatment recommendations for pregnant women. We explored the inclusion of pregnant women in treatment trials of COVID-19 by reviewing ten international clinical trial registries at two timepoints in 2020. We identified 155 COVID-19 treatment studies of nonbiological drugs for the April 7-10, 2020 timepoint, of which 124 (80%) specifically excluded pregnant women. The same registry search for the July 10-15, 2020 timepoint, yielded 722 treatment studies, of which 538 (75%) specifically excluded pregnant women. We then focused on studies that included at least one of six drugs (remdesivir, lopinavirritonavir, interferon beta, corticosteroids, chloroquine and hydroxychloroquine, and ivermectin) under evaluation for COVID-19. Of 176 such studies, 130 (74%) listed pregnancy as an exclusion criterion. Of 35 studies that evaluated highdose vitamin treatment for COVID-19, 27 (77%) excluded pregnant women. Despite the surge in treatment studies for COVID-19, the proportion excluding pregnant women remains consistent. Exclusion was not well justified as many of the treatments being evaluated have no or low safety concerns during pregnancy. Inclusion of pregnant women in clinical treatment trials is urgently needed to identify effective COVID-19 treatment for this population.

In 2012, the International Federation of Obstetrics and Gynecology (FIGO) produced a chart detailing recommended dosages of misoprostol when used alone, for a variety of gynecologic and obstetric indications. In light of new evidence 1-13 and through expert deliberation, this chart has now been revised and expanded (Fig. 1). Some areas were particularly challenging to develop given the limited, low-quality, or inconsistent evidence. The present commentary is intended to explain some of the changes and decisions made. | GENERAL CHANGESThe layout is now categorized vertically by gestation and horizontally by indication. Gestation is labelled and referred to as the number of weeks of gestation (<13 weeks, 13-26 weeks, and >26 weeks), with the final column being for postpartum use. However, in the case of incomplete abortion under 13 weeks, and inevitable abortion between 13-26 weeks, women should be treated on the basis of their uterine size rather than last menstrual period dating. Recommendations have been added for inevitable abortion and cervical preparation between 13 and 26 weeks, and for termination of pregnancy at more than 26 weeks. | NUMBER OF DOSESFor less than 13 weeks' gestation, we decided to recommend a fixed number of doses without specifying a maximum. This is because many early pregnancy regimens will be used on an outpatient basis, so it is useful for healthcare providers to know in advance how many doses to give the client; there is also sufficient evidence to support a fixed number of doses for use in pregnancies of less than 13 weeks' gestation, as well as evidence that it is safe to give further doses if they are required. [1][2][3][4]14 For 13-26 weeks' gestation, the notion of a maximum number of doses has been extrapolated from clinical research in which maximum doses are commonly noted not on the basis of patient safety issues or efficacy, 9 but rather as tangible endpoints. In clinical practice, however, they might not have great utility, and dosing should continue until expulsion, in the absence of rare complications. Suggesting that providers should discontinue dosing could actually increase risks, particularly when providers have few alternatives available if expulsion has not yet This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

CONTEXT: Peer-led RESULTS: Thirteen articles met the inclusion criteria.Pooled,adjusted results from seven trials that examined the effects of peer-led interventions on condom use at last sex found no overall benefit (odds ratio,1.0).None of the three trials that assessed consistent condom use found a benefit.One study reported a reduced risk of chlamydia (0.2),but another found no impact on STI incidence.One study found that young women (but not young men) who received peer-led education were more likely than nonrecipients to have never had sex.Most interventions produced improvements in knowledge,attitudes and intentions.Only three studies fulfilled all 10 of the assessed quality criteria; two others met nine criteria. CONCLUSIONS: Despite promising results in some trials,overall findings do not provide convincing evidence that peerled education improves sexual outcomes among adolescents.Future trials should build on the successful trials conducted to date and should strive to fulfill existing quality criteria.International Family Planning Perspectives,2008,34(2) 90International Family Planning Perspectives leagues are, as far as we are aware, the only ones specifically developed to guide the development and evaluation of peer-led interventions for young people. Their criteria for intervention development were informed by the following perspectives: that young people should actively participate in meeting their own health needs, 19 that adolescents are not a homogenous group with uniform needs 7 and that peer-led health promotion is best delivered in the context of wider sociocultural and economic health promotion strategies. 20 In addition, the authors highlighted the importance of understanding the contribution that peer-led education can offer to wider health promotion strategies.The criteria developed by Harden and colleagues were supported by findings from their review. First, echoing other authors, 21 Harden and colleagues recommended that the health needs and views of the target group be assessed; they provided examples of how specific programs in their review used this information to tailor interventions to a particular context. Second, given the challenges that they identified within peer-led education interventionsincluding resource constraints, conflicting value systems and constraints on young people's autonomy (especially in schools)-they recommended that the specific boundaries of working partnerships with young people be established prior to project implementation, such that the roles of researchers and youth are clearly defined. Third, they noted that evidence suggests that the beneficiaries of peer-led sex education include the peer educators themselves; thus, they recommended the evaluation of the effects that peer education has on peer educators, and of reciprocal education, in which each member of a target population alternates between being an educator and a recipient. Fourth, they recommended that both quantitative and qualitative methods (and if possible, an integration of the two)...

Despite promising results in some trials, overall findings do not provide convincing evidence that peer-led education improves sexual outcomes among adolescents. Future trials should build on the successful trials conducted to date and should strive to fulfill existing quality criteria.