This study was conducted to describe how women and health care professionals perceive sexual health and services that are currently provided in Saudi Arabia. Background At present, the worldwide health authority, in the form of the World Health Organisation (WHO) has drawn great attention to the importance of improving women's sexual health globally. It is increasingly concerned about women's sexual health and permanently works to shed light on the innovative approaches that are needed to raise women's awareness of risky behaviour. and to help them access the advice and treatment they need to avoid negative health outcomes that would impact on their future lives. Research into women's sexual health in Saudi Arabia will help in identifying possible causes of poor sexual health care that could be used as preventive tools in that, or similar cultures. In addition, it helps to meet women's physiological, emotional and educational needs, which is essential to support good sexual health.

Background Aboriginal youth are more likely to contract a variety of STIs versus other Canadian youth, but the determinants of sexual health in this group are seldom researched. This thesis explores condom use and sexual health among Aboriginal youth and generates recommendations for interventions. Methods Two systematic reviews were conducted examining relationships between different factors and condom use, among indigenous peoples and other diverse groups of youth. Next, qualitative interviews were conducted with 30 Aboriginal youth in British Columbia, Canada. Finally, a secondary analysis of cross-sectional data from a large, representative survey was performed to model relationships between various exposures and ever having sex, having more than one sexual partner, condom use, STI diagnosis and pregnancy involvement. Results The two systematic reviews revealed serious potential bias in studies assessing condom use among indigenous peoples and other diverse groups. Few factors were tested across populations, and little insight was gained as to which factors may differ in their relative importance. In the qualitative study, youth with less stable family relationships and negative life experiences described more risky sexual behaviour than those who did not. Both genders engaged in coercive sexual negotiation, and sometimes young women insisted on condom non-use. Youth also described concurrent/serially monogamous relationships with rapid rates of partner change. These relationships could be 'serious', and 'serious' relationships could denote an acceptable context for pregnancy. In the cross-sectional study, substance use, unwanted sex, and living on reserve increased risk of multiple outcomes. Feeling more connected to family was strongly protective for both genders, and for girls, helping out in the community was also protective. Conclusions Interventions addressing substance use, sexual communication and family relationships may be efficacious for improving sexual health among Aboriginal youth. Building on youth's own ideas about positive lifestyles could be an effective method of tailoring.

The correct level of public funding of sexual health services, particularly contraception and abortion (fertility control) remains controversial. As with other services, decision making requires appropriate evidence. This thesis, by reviewing current policy, identified two questions pertinent to decision makers in the English NHS, namely what is the cost and benefit of improving access to abortion and contraception. By critiquing current theory, as illustrated by the National Institute of Health and Clinical Evidence technology appraisal methods, it set out a new theory of evidence quality, defined according to its usefulness in decision making. General recommendations for economic evaluation were then deduced for dealing with uncertainty and measuring benefit, defined as the extent of fulfilment in decision makers' goals. In the empirical part of the thesis firstly, qualitative methods showed the range of measures of benefit, including access and user choice. Secondly, a systematic review of economic evaluations in fertility control showed their inadequacy in addressing the policy questions and made recommendations for economic evaluations specific to fertility control. Two economic evaluations were then conducted to examine the cost and consequences of improved access to contraception and abortion methods according to women's preferences. The first showed that greater choice of contraceptive methods could save up to £500 million over 15 years and reduce the annual number of unintended pregnancies by about 55,000 and annual number of abortions by about 22,000. The second showed that reducing the mean gestational age at abortion by about 9 days could increase the percentage of abortions within 10 weeks and save about £9 million over 15 years. Allowing women to choose medical abortion would produce greater savings. Sensitivity analyses largely supported these findings. Finally, limitations of the theoretical and empirical parts were discussed and recommendations for economic evaluation generally and specific to fertility control made.

This thesis examines how a diverse group of participants in England make sense of condom use, exploring how talk about condoms relates to the operation of and resistance to social inequalities, and examining how public health discourse is taken up and reformulated in everyday talk about sex. It takes a feminist, discursive rhetorical approach, combining this with an exploration of how particular discourses about condom use can be understood to be ideological. The thesis draws on data from surveys, interviews and a media case study of The Jeremy Kyle Show: situating a fine-grained analysis of the discursive construction of condom lise within the context of a broader understanding of the operation of power in the everyday. In addition, the work develops the use of private diaries as a tool for interview research about intimate life. The research explores how talk about condom use can work to construct subjects, developing the concept 'safer sexual subjectivity'. The discursive construction of ' safer subjects' was found to work in complex ways with existing social categories such as 'race', class and gender, with particular subjects marked as more 'risky' than others. Talk about condom use reproduced, resisted and reworked norms of gender, sex and relationships. New norDis of gendered responsibility positioned skillful condom use as a strategy of selfcare and regulation of neoliberal sexual subjectivity. Public health discourse was taken up and reworked by participants, producing new forms of intimacy and desire. The thesis concludes that the negotiation of condom use is not simply an in the moment activity that happens during sex, or a 'healthy choice' made by rational actors. Talk about condom use serves rhetorical purposes in positioning people and communities, categorising relationships and developing norms about sexual practices and gender identities.

No description available.

Key messages within the government white paper Valuing People Now (Department of Health, 2009) include that people with learning disabilities have the right to develop relationships, to be parents and to marry or have a civil partnership. This study examined how staff in a learning disability service talk about sexuality support and how they negotiate the empowerment of service users in relation to their sexual rights. These questions were addressed through a discursive psychological analysis of one-to-one interviews with eight members of staff working in a service providing both outreach and residential support to people with I'earning disabilities. The analysi,s demonstrated that how staff support service users' sexual rights, and the opportunities they do or do not create for service users to develop intimate relationships, is not simply a manifestation of internal, individual, 'attitudes', but rather, is a result of the complex relationship between language, the historical; social and cultural context, regulatory practices and institutional structures. Before staff begin to think about providing support in this area, they have to make sense of whether the person they are supporting has a moral entitlement ~o a sexual identity. Some staff in the study drew upon a romantic discourse of sexuality (Hollway, 1989), which produced service users as 'asexual'. However, other staff drew upon discourses of sexuality that were broader than the romantic discourse and this helped to construct people with learning disabilities as partially, if not fully entitled to a sexual identity. The analysis also demonstrated that in providing sexuality support, staff members have to negotiate a number of practice dilemmas. For example, staff have to manage competing service priorities, such as those of 'health' and 'risk management', consider their personal and professional boundaries and interpret (vague) service ideologies of protection and empowerment. Underlying some of these difficulties are problems with the interpretation of the philosophy of 'normalisation' (Wolfensberger, 1980) as it applies to the sexual lives of people with learning disabilities. Implications of this analysis for clinical psychologists, services and policy are discussed and a number of recommendations are made for clinical practice. These include clinical psychologists taking a role in person centred planning processes, supporting staff to take a deconstructive approach to sexuality and to find a respectful way in which to talk about such a culturally taboo topic.

This study aims to analyse policy and political processes at multiple levels, and examine the consequences for Sexual and Reproductive Health (SRH) care development arising from the engagement of a participatory movement in Peru. I used Associations of Local Community of Health Administration (CLAS) as a core organisation for Peru’s major participatory model at local level. With policy makers, NGOs, health workers and (potential) service users, I explored factors that facilitated/prevented women’s participation in decision-making mechanisms and health practices. I employed a case study and multi-disciplinary approach at national, regional and local levels, focused upon women from multiple aspects in Andean Peru. I studied rural, periurban CLAS and non-CLAS models to compare across the case studies. I conducted semi-structured in-depth interviews with 116 respondents, unstructured observation, and documentary analysis in 2004. My analytical frameworks focused upon: ‘policy content’, ‘context’, ‘actors’, ‘process’, ‘patterns of participation’, and ‘outcomes and impacts’. Political, economic, legal and technical were identified which reflected the stagnant state of the development of SRH and CLAS policies. The central policy focuses on a narrow sense of SRH care, and neglects Reproductive Tract Infections (RTIs). Central government’s weak political leadership and stewardship to CLAS policies reflected that personal leadership (e.g. regional health directors) can define the destiny of regional CLAS development. Facilitating factors were led by NGOs and mixed factors were led by donors. CLAS appeared to create favourable conditions/environment for women’s participation in the community. Local respondents in the CLAS system understood the importance of participation to solve local problems compared to their non-CLAS system counterparts. Nevertheless, women in CLAS model had no influence on changes of SRH agenda, despite difficulties in the acquisition of contraceptives and effective RTIs medicines. The following actors must be incorporated into the decision-making and evaluation/feedback mechanisms in CLAS model to achieve more gender, age-gentle, and ethnically-sensitive Local Health Programmes and strengthen a rights- and trust-based approach: women’s Grassroots organisations, Defence Committees of Women’s Rights, Community Health Agents, Committees of Communal Development or Health (CODECOS)/(COSACOS), and traditional health providers. Alternative relationships (e.g. rapprochement) between CLAS and government authorities must be sought.

This research examines sexual health (SH) policies and experiences of youth, using the Maldives as a case study. Youth SH is a controversial and under-researched issue in The Maldives, an Islamic state where premarital sexual activity is a punishable offence. This thesis addresses the question: To what extent, and why is there a mismatch between official Maldivian SH policies, services and data and the lived experiences of youth in Maldives? It is a mixed methods study involving four research methods and sets of data: i) qualitative in-depth interviews (n=61) with youth aged 18-24 years from three sites within the Maldives; ii) key informant interviews (n=17) with policy actors and service providers; iii) a web-based quantitative survey of Maldivian youth (n=480); and iv) secondary analysis of the Maldives DHS 2009. There are four main findings from this research, three of which are substantive, and one of which is methodological. Sociocultural and religious factors heavily influenced policymaking, service provision and youth experiences. Contrary to most theocratic states, the SH policymaking process in the Maldives is shaped by policy actors and institutions whose strengths have more sociocultural basis than religious expertise. Whilst published official data and original secondary analyses of the MDHS suggest that premarital sexual activity among youth is very limited; this thesis finds extensive reporting of sexual activity. This contrast was also reflected in youth’s knowledge of STIs- where official data displayed a higher level of awareness than found through in-depth interviews and the web-based survey- and their experience of unwanted pregnancies and abortions, which appear to be under-reported in official data. Analyses of the web-based survey using the same questions as the DHS show significantly higher levels of reporting of sexual activity, showing a strong modality effect on survey response. Results from the web-based survey demonstrated that if sociocultural factors were removed from questionnaire design (e.g. censorship of certain issues) and administration (e.g., privacy and anonymity- difficult to achieve in small island communities typical of the Maldives); it is possible to improve response rates and quality of the data. Finally, this thesis highlights two key characteristics of the relationship between SH policy, services, data and youth experiences in the Maldives. Firstly, youth SH experiences appear to be disconnected from SH policies, services and data. Secondly, there is a mutually reinforcing relationship between official SH data and policies, where restrictive policies dictate the type and extent of data that may be collected, which then reinforce justifications for the current restrictive policies and limited services. Policy implications of this research include identifying and addressing the links between SH policymaking and religious and sociocultural factors, and addressing the subsequent effect on SH policy and services for youth.