MPH / Department of Public Health / See the attached abstract below

Thesis (M. A. (Family Medicine) -- University of Limpopo, 2021 / Background: This study sought to understand men's attitudes towards birth control measures practised by their partners in the Mamitwa area located in the Greater Tzaneen Municipality, which falls under the Mopani District in Limpopo Province of South Africa. Methods: A qualitative descriptive study using Focus Group Discussions (FGDs) with purposively selected men aged 25-60 years in a relationship with women of childbearing age was conducted in 2019 in the Mamitwa area. Open-ended question guide was used to explore men perceptions regarding Family Planning and discussions were recorded, translated, and transcribed verbatim. Transcripts were coded and analysed thematically. Results: Three major themes were identified, namely: (i) Perceived advantages of Family Planning, including financial benefits, Prevention of STIs and unwanted pregnancy; (ii) Perceived disadvantages of Family Planning, including adverse effects of Family Planning on men and women and marital difficulties; and (iii) Communication with men about Family Planning, including healthcare workers, were being blamed for excluding men in Family Planning discussions. Conclusion: Men had favourable attitudes towards Family Planning use. However, there is a lack of adequate information about Family Planning, thus causing men to doubt allowing their respective female partners to use Family Planning. This underscores the need to educate and involve men in Family Planning programs. Key Concepts: Family Planning; Attitudes; Perception; Men Family Planning Use

Thesis (DPhil)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: The study describes and analyses changes in women's reproductive behaviour ID developing communities. These changes took more than hundred years to occur ID Western communities but only two to three decades in developing communities such as Taiwan and Barbados. The population of Victoria East district of the Eastern Cape province of South Afiica was chosen as a case study of these changes. Changes in the reproductive behaviour of women are described over a period of twenty-two years. The base year for the study is 1978 and data were collected up to 2001. Changes increased in particular since 1988. Statistical descriptive analyses were undertaken with regard to patterns of changes in variables such as age at the onset of births, child spacing, the mean number of births per woman, fertility regulation, and the number of children ever bom. Variations in patterns were analysed according to age cohorts, occupation and marital status. Information regarding these variables was collected from records at hospitals and clinics. Focus group interviews were held to reflect women's own descriptions and experiences regarding these variables. The research design thus combines the quantitative and qualitative approaches. The findings confirm a pattern of fertility decline that Caldwell described as the African pattern, which is different from that seen in Europe and Asia. It is characterized by a progressive delay in onset of childbearing and reductions in the mean number of childbirths that occur across all age cohorts and are associated with contraceptive accessibility. The high incidence of non-marital childbearing in the Victoria East district however sets the population studied apart from the polygamous Afiican societies on which Caldwell based the African transition. In this respect the population considered resembles the scenarios seen in Latin America, the Caribbean, Botswana and in recent years Europe. The study population shows a divergence in the patterns of marital and non-marital childbearing, with marital childbearing following the African pattem. Because of its high incidence, non-marital childbearing is dominant and the major contributor to the fertility decline that is afoot. The implications of this pattern needs much more in-depth study before comparisons with the above-mentioned communities can be made. / AFRIKAANSE OPSOMMING: Die studie beskryf en ontleed veranderinge in vroue se reproduktiewe gedrag in ontwikkelende gemeenskappe. Hierdie veranderinge het in Westerse gemeenskappe meer as honderd jaar geneem om plaas te vind maar slegs twee tot drie dekades in ontwikkelende gemeenskappe soos Taiwan en Barbados. Die bevolking van die landelike Victoria-Oosdistrik: in die Oos-Kaapprovinsie is gekies as 'n gevalstudie daarvan in Suid- Afrika. Veranderinge in die reproduktiewe gedrag van vroue in hierdie gemeenskap word oor 'n periode van twee-en-twintigjaar beskryf Die basisjaar van die studie is 1978 en data is ingesamel tot en met 2001. Veranderinge het veral toegeneem vanaf 1988. Statistiese-beskrywende ontleding is gedoen ten opsigte van patrone van verandering in veranderlikes soos die ouderdom by die skenk van geboorte, geboorte-spasiëring, die gemiddelde aantal geboortes per vrou, fertiliteitsregulering en die aantal kinders ooit gebore. Variasies in patrone is ook na aanleiding van huwelikstaat en beroep bepaal. Inligting aangaande hierdie veranderlikes is verky vanaf rekords wat by hospitale en klinieke gehou word. Fokusgroeponderhoude is ook onderneem waarvolgens vroue se eie beskrywings en ervarings aangaande die genoemde veranderlikes verkry is. Groepe is saamgestel volgens verskeie ouderdomskohorte en huwelikstaat. Die navorsingsmetodologie behels dus 'n kombinasie van kwantitatiewe en kwalitatiewe benaderings. Die bevindings bevestig 'n patroon van fertiliteitsafhame wat deur Caldwell as die Afrikapatroon beskryf word en afwyk van die Europese en Asiatiese patroon. Dit word gekenmerk deur 'n progressiewe vertraging in die aanvang van geboorte-skenk, afhame in die gemiddelde aantal geboortes oor al die ouderdomskohorte en word geassosieer met kontraseptiewe toegankliheid. Die hoë voorkoms van buite-egtelike geboortes in die Victoria-Oosdistrik onderskei egter die bestudeerde bevolking van die poligame Afrika gemeenskappe waarop Caldwell die Afrika-oorgangstipe gebaseer het. In hierdie opsig vertoon die bevolking eerder ooreenkomste met ontwikkelende gemeenskappe m Suid-Amerika, die Karibbiese Eilande, Botswana en die meer onlangse Europa. Die bestudeerde bevolking vertoon uiteenlopende patrone van binne-egtelike en buite-egtelike geboortes met die binneegtelike patroon meer in ooreenstemming met die Afrika-patroon. Die hoë voorkoms van buite-egtelike geboortes domineer egter die algehele patroon en kan beskou work as die hoof bydraende faktor in the afhemende fertiliteit wat waargeneem is. Die implikasies hiervan moet egter veel dieper studie ondergaan alvorens verdere vergelykings met die bogenoemde gemeenskappe gemaak kan word.

A study investigating the contraceptive knowledge, attitudes, beliefs and practices of coloured unmarried pregnant teenagers.

This Dissertation is submitted in partial fulfilment of the Master of Arts in Demography and Population Studies at the University of the Witwatersrand, 2017 / Background: In South Africa, poor choice of contraception method or contraceptive failure has been noted as one of the key contributors to high rates of unwanted pregnancy and HIV/AIDS. Contraceptive use is highly correlated with pregnancy and fertility intention. While research knows the role of contraceptive use in delaying conception and/or childbearing, what remains unknown is an understanding of whether the methods of contraception used by young women match their fertility intentions. The objective of this study is to determine the relationship between fertility intention and method of contraception among young women (20-24 years old) South Africa. Methods: This study provides a secondary data analysis on cross-sectional data from the 19992002 Transition to Adulthood in the Context of HIV/AIDS survey. Given that the survey involved two waves of data collection in 1999 and 2002, the two respective datasets are pooled together to achieve a representative sample of 8 370 adolescents aged 14 – 24. However, because the population of interest is young women, further sample restrictions are performed and a weighted sample of 1,020 sexually active young women aged 20-24 years old is attained. A multinomial regression is adopted for this study because the outcome variable-method of contraceptioncomprises of three categories: (1) modern method (2) traditional (3) no method. As such, in establishing the relationship between fertility intention and method of contraception, three levels of analysis are carried out. Firstly, is a univariate analysis of the variables in the study, followed by a bivariate analysis using Chi2 to examine the association between predictor variables and method of contraception. Finally, a multivariate analysis producing the adjusted and unadjusted associations is conducted to examine whether a statistical relationship exists between fertility intention and method of contraception. Results: Of the 1,020 sexually active young women 20-24 years old years old in the sample, 77.8% do not use any method of contraception while 13.9% make use of modern methods and only 8.1% use traditional methods of contraception. There was no significant association found between fertility intention and method of contraception. Among young women that intend to have three or more children in their lifetime compared to those that intend to have 1-2 children, the relative risk of using a modern method of contraception compared to not using any method of contraception is expected to decrease by a factor of 0.620 (95% CI=0.351,1.095; P>0.05). However, positive associations were found between relationship status and method of contraception as well as between place of residence and method of contraception. Among young women that have steady partners compared to those that are single/not in a relationship, the relative risk of using a traditional method of contraception compared to not using any method is expected to decrease by a factor of 0.274 (95% CI=0.122, 0.617; P<0.05). Furthermore, among young women living in rural areas compared to those in urban areas the relative risk of using a modern method of contraception compared to not using any method is expected to decrease by a factor of 0.499 (95% CI=0.300, 0.831; P<0.05). Conclusion: This study has demonstrated that fertility intention cannot be used as the sole predictor of the choice of contraception used by young women. Rather, there are prevailing and contextual demographic and socio-economic factors that intervene this relationship and influence women’s adoption of any method of contraception. Notably, the limited access to healthcare centres; ambivalent feelings about pregnancy as well as misconceptions and perceived side effects of contraception influence the poor use of modern methods of contraception. To address the high rate of unwanted pregnancy among youth in South Africa, it is advisable that policies and programmes assist young women to become decisive about their fertility intentions and provide them with the necessary support and resources to access contraceptive methods that will assist them in achieving their fertility goals. / XL2018

A study investigating the contraceptive knowledge, attitudes, beliefs and practices of coloured unmarried pregnant teenagers.

This study investigated influence strategies used by university students to negotiate condom use. The study examined the seven condom influence strategies (CISs) -withholding sex, direct request, seduction, relationship conceptualizing, risk information, deception, and pregnancy prevention- used by heterosexually active male and female students. The sample comprised of 156 first year students (male=44 and female=112). Statistically significant correlations were found among all the condom influence strategies subscales. Results suggest that the university students influence their partners in all identified condom influence strategies and the risk information strategy holds the most promise of all the strategies.

MCur / Department of Advanced Nursing Science / Background: Adolescent sexual health is fundamental to the physical and emotional health, and well-being of individuals, couples, and families, as well as the social and economic development of communities and countries. The purpose and the aim of this study was to explore and describe the community’s perceptions of adolescent sexual health in Mutale Municipality, Vhembe District of Limpopo Province. Methodology: The research design of this study was qualitative, explorative, descriptive and contextual in nature. The population comprised of every adult community member or resident of Tshiungani Village. Both genders were included in the sample. Parents and guardians of adolescents made up the sample. Data were collected by means of in-depth face-to-face interviews. Data were analysed qualitatively using Teschs’ qualitative analysis. Findings: The study involved six themes, six categories and nineteen sub-themes. The community expressed concerns related to degradation of cultural norms and values, change in family structure, effects of media, politics, religion and poverty as affecting adolescent sexual health. Conclusion: The study explored and described the perceptions of community members regarding adolescent sexual health although the findings could not be generalized as it represents only part of the population. Recommendations: The study recommended intense sexual health education and promotion at early primary phase, career guidance to enhance and promote selfesteem, parental and community involvement in assisting and engaging adolescents with life skills within communities.

MCur / Department of Advanced Nursing Science / See the attached abstract below

Department of Advanced Nursing Science / PhDH / Background: Despite measures to curb unwanted pregnancies and to sustain and expand abortion services, a high number of complications and deaths still occur. The failure of these measures is evidenced by the high number of women who are admitted to the public hospitals of KwaZulu-Natal Province with complications from induced abortions. KwaZulu-Natal Department of Health has repositioned Family Planning to a key priority in its health program in order to improve the situation for women. However, in order to improve the situation, it is necessary to understand the underlying causes. This study sought to identify challenges that affect women's access to Post Abortion Care (PAC) services in KwaZulu-Natal Province, South Africa. It also sought to shed light on the challenges faced by those who render PAC services, as well as assess the skills of those workers as observed while they provided PAC services. After conducting the research on challenges related to access and rendering of post abortion care services, the researcher identified a need to develop guidelines for management of unsafe and induced abortion complications, with the aim to improve the life expectancy of women and prevent maternal deaths. Therefore, an outcome of the study was the development of a PAC management guideline. Purpose: The purpose of the study was two-fold: Phase 1: to explore the challenges faced by women when accessing PAC, and the health care workers who render PAC services, and to assess the PAC skills of the health care workers; Phase 2: to use the findings of Phase 1 to develop guidelines for post abortion care management at selected Hospitals of KwaZulu-Natal Province, South Africa. Methods: The design of the study was guided by the Andersen model of Health Care Utilization. The model focuses on the contextual factors - enabling factors, predisposing factors and need factors - that influence the individual's utilization of health care services. Five districts of KwaZulu-Natal Province, South Africa were selected for the study. A convergent parallel mixed method was used to collect and interpret the data. A qualitative study was used to explore perceptions and challenges of women when accessing PAC; this was carried out by means of in-depth interviews with 23 women who accessed PAC services. Five Focus Group Discussions (FGD) were carried out with 50 health care workers to explore the challenges they experienced when managing abortion complications. A quantitative approach was used for direct skills observation of 92 health care workers. Thematic analysis was used to analyse the qualitative data; descriptive statistics were used to analyse the quantitative data. Results: From the in-depth interview data, several main themes were identified. Women who accessed PAC identified a lack of facilities that offered PAC service, distance from the community to the hospital that provided PAC service, lack of transport, shortage of staff, unskilled staff, shortage of equipment, long waiting queues, stigma and discrimination as challenges associated with delay or avoidance of access to post abortion care services. The main themes raised by the health care providers were lack of support from the management, shortage of staff, lack of training, burnout, unavailability of the guidelines or protocols and shortage of equipment. The quality of PAC services was perceived as poor by both the women seeking care and the health care workers. The main concerns raised by the women were lack of respect, lack of privacy, sharing of bed and insufficient time with the health care provider. The results confirmed that guidelines are needed for the management of post abortion care services. The findings from the qualitative and quantitative parts of the study were used by an expert group to develop PAC management guidelines. The development of the guidelines was in accordance with the WHO models, PICOS & GRADES. The guidelines were validated by the group using a close-ended checklist, analysed with simple descriptive statistics. Conclusion: This study concludes that access to comprehensive quality post abortion care must be provided for all women at times of need. Quality PAC services should be rendered by skilled health care workers in a facility which is accessible and well equipped with functional equipments and updated guidelines. Recommendations: The study therefore recommends that measures should be taken to ensure the provision of quality PAC services. The PAC services should be accessible with the increased number of facilities, adequate trained health care workers with functional equipment and guidelines. Health care workers must receive training and management support to enhance quality PAC services. Privacy and respect must be maintained during provision of PAC services to ensure quality of care and increase demand. There must be continuous community awareness about PAC services which will encourage early-seeking behavior, and reduce fear of stigma and discrimination by the providers of PAC services before the complications arises. This study did not cover all the districts to identify the challenges on delaying PAC service. Therefore, this study recommends additional clinical, operations and community research which will give broader details and understanding on the challenges that cause delay for seeking immediate post abortion care services. / NRF