Thesis advisor: Rosanna Demarco / For 21 years (1983-2004), the civil war in Sudan concentrated in the South resulting in massive population displacements and human suffering. Following the comprehensive peace agreement in 2005, the government of South Sudan is rebuilding the country's infrastructure. However, the post war South Sudan has some of the worst health indicators, lack of basic services, poor health infrastructure and severe shortage of skilled labor. The maternal mortality ratio for example is 2,054/100,000 live births, currently the highest in the world. Abortion complication leads among causes of admission at the gynecology units. This research contributes nursing knowledge on reproductive health among populations affected by war. The purpose was to explore the experiences of women with abortion complications in the post war South Sudan. Using qualitative descriptive methodology, in-depth interviews were conducted with 26 women following treatment for abortion complications at the gynecology unit of a county hospital. Data was collected from March 2nd to April 26th, 2008. Spontaneous abortion was the most common among study participants. Post abortion care was nonexistent at the community level health facilities, but present at the hospital. The women interviewed were reluctant to reflect in-depth about their experiences with abortion complications. They described the process, signs, symptoms and the events that led to the pregnancy loss, and were more concerned about regaining their reproductive function, a societal expectation of a married woman in South Sudan. A female child in South Sudan is assigned a "special" role in the family and community - that of getting married, attracting a high bride wealth paid as dowry to her parents and delivering children for the husband. Arranged and/or forced early marriage is common. A woman's world view about reproductive health and experiences with abortion complications is therefore influenced by this cultural context. Implications of these findings include the need to develop the nurse midwifery profession in South Sudan. Nurse midwives can lead in providing gender and culturally sensitive reproductive health services including post abortion care. Plans for care must include opportunities to listen to women's perspectives. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Chapter 2 evaluates the effectiveness of two simple and widely applied self-report psychometric questionnaires: the 12-item General Health Questionnaire (GHQ-12) and Beck Depression Inventory (BDI) in detecting psychological morbidity after miscarriage. Both GHQ-12 and BDI demonstrated satisfactory psychometric properties and both questionnaires were found to be effective in detecting general psychiatric disorders and depression respectively. / Chapter 3 reports the application of GHQ-12 and BDI in assessing the psychological well-being of 280 miscarrying women over a one-year longitudinal course after the loss. The psychometric outcomes were also compared with a community cohort unexposed to pregnancy loss. The study confirmed that although psychological distress reduces over time, the psychological impact following miscarriage is significant and could be enduring. Patients who were more distressed immediately after miscarriage continued to be at a higher risk of psychological morbidity at a later stage. / Chapter 4 assesses the possible underlying risk factors associated with psychological morbidity following miscarriage over a one-year longitudinal course. It has demonstrated that while a poor marital dyad and psychological distress experienced immediately after miscarriage are consistent predisposing factors, some obstetric variables such as the type of medical management, a history of abortion and prior ultrasound evidence of fetal viability contribute to the development of psychological morbidity at various time points along its evolutionary course. / Chapter 5 reports a randomised controlled trial involving 280 miscarrying women in assessing the effectiveness of a psychological counselling programme in reduction of psychological morbidity. A 30% reduction in the proportion of patients with psychological morbidity was found three months after miscarriage in the counselling group, suggesting a potential clinical beneficial effect, albeit not statistically significant. This potential effect was more profound for selected patients who were initially more distressed after miscarriage. / Chapter 6 reports our exploratory findings of the psychological reaction of 83 male partners after miscarriage and it reports the gender differences over a one-year longitudinal course. A significant proportion of men were found to report psychological distress and depressive symptoms immediately after miscarriage. When compared with their female partners, the psychological impact was less intense and less enduring. / Chapter 7 concludes the thesis and proposes directions for future research. / Miscarriage (spontaneous abortion) is the most common complication of pregnancy with 15-20% of clinically recognised pregnancies aborting spontaneously. It is also one of the commonest gynaecological conditions leading to hospitalisation, accounting for more than 10% of gynaecological admissions in Hong Kong. The common occurrence and the procedural simplicity involved in the medical management, however, may tend to obscure its psychological impact. While emerging evidence has suggested that miscarriage could be associated with significant and possibly enduring psychological consequences, many questions remain unanswered, such as how to detect and screen for psychological morbidity after miscarriage; how long the symptoms last or when do they resolve; what are the underlying risk factors throughout its longitudinal course; what is the psychological impact on the male partner; and whether psychological intervention is helpful. In addition, nearly all studies have been conducted in Caucasian societies with the effect on other ethnic groups remaining largely unexplored. / This thesis specifically addresses the following aspects in assessing and managing psychological morbidity following miscarriage: Chapter 1 firstly introduces the clinical aspects of miscarriage, including the definition, incidence, risk factors, clinical manifestations and the current management options. It then discusses the current evidence available on the psychological aspects of miscarriage and outlines the deficiency in current knowledge. Finally, the hypotheses for this thesis are proposed. / Lok Hung Ingrid. / "May 2006." / Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1567. / Thesis (M.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 248-276). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

In the first phase of this study, the cluster analysis results of 208 WEM provided initial empirical support for this typology. Three subtypes of WEM were identified. They were "Adjusted Women" (AW, N = 54, 26%), "Dysphoric/Mixed Type Women" (DW, N = 57, 27%), and "Gender-Bound Women" (GW, N = 97, 47%). Partially supporting the hypothesis, GW experienced the worst adjustment as reflected in their high level of perinatal grief symptoms compared to AW and DW. Further examination of the demographic characteristics of each WEM subtype showed that while DW reported relatively stronger personality (i.e., trait anxiety, trait depression, and neurotic personality) and cultural vulnerabilities (i.e., traditional ideal personhood and self-sacrifice) compared to AW, GW's reports of personality and cultural vulnerabilities faked the worst among the 3 WEM subtypes. Cluster-constrained hierarchical regression analyses revealed a distinct set of predictors for immediate postloss adjustment of AW, DW, and GW. Instead of a complete nested model, the present data fitted a partially nested model where AW were nested within GW, and DW represented a mixed type of WEM. Specifically, AW's perinatal grief was affected by pregnancy factors whereas GW's was affected by pregnancy, personality, and cultural factors. DW's perinatal grief was not affected by pregnancy factors but by personality and cultural factors. / In the fourth phase of this study, pregnancy, personality, and cultural factors as well as spousal emotional social support were reexamined for their possible implications for WEM's and the pregnant controls' psychological distress, state anxiety symptoms, and state depressive symptoms at 6 months following the initial assessment. The results showed that spousal emotional support at a 6-month follow up was a salient predictor of psychological distress state anxiety symptoms, and state depressive symptoms at 6 months after the initial assessment for both WEM and the pregnant controls While spousal emotional support at the initial assessment did not have the same effect, this result suggested that to mitigate the longer term poor psychological adjustment of WEM and pregnant women, sustained spousal emotional support is needed. Trait anxiety at the initial assessment was also a strong predictor of WEM's psychological distress, state anxiety symptoms, and state depressive symptoms at 6 months post miscarriage. Pregnancy factors at the initial assessment were only moderately related to the psychological adjustment of WEM and the pregnant controls, and cultural factors at the initial assessment were not related to any of the adjustment indicators at the 6-month follow up. (Abstract shortened by UMI.) / In the second phase of this study, comparisons were made between the 3 WEM subtypes and women with healthy uncomplicated pregnancy (pregnant controls, N = 258). The results showed that the 3 WEM subtypes experienced varying levels of adjustment problems---that is, psychological distress, state anxiety symptoms, and depressive symptoms---compared to the pregnant controls. GW, in particular, were 8 times more likely to be classified as psychological distress caseness and 4 times more likely to be classified as state anxiety caseness and state depression caseness, even after controlling for pregnancy factors and spousal emotional social support. / In the third phase of this study, the author attempted to establish predictive validity of the proposed WEM typology using 6-month 2-wave longitudinal data A subsample from Phase One and Phase Two of this study, including 103 WEM (AW = 33, 32%; DW = 27, 26%; GW = 43, 42%) and 139 pregnant controls, provided information on their psychological distress, state anxiety symptoms and depressive symptoms, as well as on their motivation to reproduce at 6 months after the initial interview. Although GW were significantly more likely than AW and DW to report being pregnant or having the intention to conceive at 6 months post miscarriage, no significant differences were observed between the 3 WEM subtypes in their psychological distress, state anxiety symptoms, and state depressive symptoms. / The present 4-phase study was an attempt to propose an integrated conceptual model to advance understanding of Chinese women's adjustment to miscarriage; that is the perinatal grief symptoms, psychological distress, state anxiety symptoms, and depressive symptoms they experience in response to miscarriage. Through a comprehensive review of sociobiological theory, attachment theory, psychoanalytic theory and the feminist perspective, the author proposes a conceptual model involving 3 major pathways, namely pregnancy, cultural, and personality factors. It was hypothesized that 3 subtypes of women who experienced miscarriage (WEM) (Adjusted Women, AW; Dysphoric Women, DW; Gender Bound Women, GW) could be identified with each subtype being affected by a combination of different factors. Specifically, it was hypothesized that AW would be affected by pregnancy factors, DW by pregnancy and personality factors, and GW by pregnancy, personality, and cultural factors. / Yan Chau Wai Elsie. / "June 2007." / Adviser: Catherine So-Kum Tang. / Source: Dissertation Abstracts International, Volume: 69-01, Section: B, page: 0705. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 104-120). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Thesis. 1980. Ph.D.--Massachusetts Institute of Technology. Dept. of Linguistics and Philosophy. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND HUMANITIES. / Bibliography: leaves 339-341. / Ph.D.

This thesis explores the topic of shame through my perspective as a pro-choice woman and future educator. It tells of the long relationship I have had with shame, which began when I had my first abortion. It also describes the history of shame inflicted on the women of Ireland, who continue to fight for their reproductive rights. I use these narratives to support my position that educators have a responsibility to create safe spaces for controversial topics and vulnerable populations on university campuses.

Both pro-life and pro-choice viewpoints on the moral status of abortion have important insights to offer, but these insights can be difficult for opponents to discern and appreciate. This thesis seeks to uncover and explain some of the underlying moral convictions that inform debates on abortion. Such an inquiry, undertaken within the context of religious ethics, is important for several reasons. First, it educates the public about religious and moral beliefs that are often hidden behind popular slogans. Second, it reveals some common moral convictions, and it may point to the possibility of greater moral agreement. Third, it also reveals stark differences. These differences may continue to divide people, but they ought at least to be better understood. Fourth, this inquiry has the potential to deepen mutual understanding, respect, and civility among people who have strong feelings about abortion, but are also people of good will, for it challenges fellow citizens to encounter each other as intelligent, concerned individuals who are doing what they can to construct a social order that reflects their deepest religious and moral values.

<p>The treatment that women get from health care staff can influence the experience of the abortion and how women manage to coping the experience emotionally. The aim of this study was to illuminate women’s experiences in connection with an abortion. The findings show that the women’s social situation led them to the decision of abortion. When the women had the pregnancy confirmed many felt unreality. Several women experienced the situation as a crisis. After the abortion most of the women experienced relief, but also guilt towards the abortion. Some knew that they had made the right decision, while others felt regret. Most of the women experienced that the nursing staff treated them well, but some women experienced that the staff was negative, insensitive and ignoring. Most of the women was satisfied with the total support from significant others. To make a satisfying nursing care possible for each woman who seeks abortion, more research is needed about women’s experiences of nursing staff’s treatment.</p>

The treatment that women get from health care staff can influence the experience of the abortion and how women manage to coping the experience emotionally. The aim of this study was to illuminate women’s experiences in connection with an abortion. The findings show that the women’s social situation led them to the decision of abortion. When the women had the pregnancy confirmed many felt unreality. Several women experienced the situation as a crisis. After the abortion most of the women experienced relief, but also guilt towards the abortion. Some knew that they had made the right decision, while others felt regret. Most of the women experienced that the nursing staff treated them well, but some women experienced that the staff was negative, insensitive and ignoring. Most of the women was satisfied with the total support from significant others. To make a satisfying nursing care possible for each woman who seeks abortion, more research is needed about women’s experiences of nursing staff’s treatment.

My honors capstone project deals with the issues of reproductive rights and onscreen representations of women. I created a performance-based documentary style piece entitled Talk Over Me. It focuses on men’s opinions and stories surrounding abortion and conveys the disconnect between a woman’s face on screen and her opinions, thoughts and personal identity.

The purpose of this feminist action research project was to produce a practical support volunteer training and manual for the Georgia Reproductive Justice Access Network (GRJAN). Founded in 2011, GRJAN is a grassroots, reproductive justice abortion fund that provides abortion funding and until 2012, practical support (lodging, transportation, and childcare) to low-income individuals seeking abortion services in Atlanta, GA. The resultant thesis is a reflective essay upon the project, documenting and analyzing the successes and failures of the project as well as discussing the limitations of pursuing feminist activist work within the academy.