In Ethiopia the number of young people going to college is steadily increasing. This predisposes them to risky sexual behaviour which leads to unwanted pregnancy, unsafe abortions and HIV. This study has aimed to determine the patterns of sexual practice and contraceptives use and risk behaviours among those students in central Ethiopia. A descriptive cross-sectional survey was employed. Data on sexual practice, knowledge and contraceptive use were collected from 327 college students. The data were cleaned, entered and analysed using SPSS version 20. The results revealed that despite their knowledge of the methods of safe sex, there are still considerable misconceptions regarding the effectiveness of contraceptives, their side effects and their proper use. In terms of the sexual practice reported by the respondents, 142 (43.4%) practised sex and 110 (77.5%) of respondents had used contraceptives at least once. The age of the respondents, the number of years for which they stayed in college and their fields of study were significantly associated with their sexual practice. In conclusion, a significant number of college students practised sex without using contraceptives to prevent pregnancy, and a considerable number of their partners disapproved of the use of contraceptives / Health Studies / M.A. (Public Health)

Although Sweden invests a great deal of money and effort in prevention work, STIs are a major problem in our society. Young people are at high risk both when it comes to unwanted pregnancies and STIs and several studies have revealed that the condom use is quite low. Condom use is a complex issue. There are often several factors that interact and affect the decision to use or not use condom. The result in this thesis shows that young people have behavioral expectation to use condom, especially for anal sex and vaginal sex with a casual partner (both known and unknown). At the same time, the condom use is low irrespective of type of partner and type of sex. Approximately 20 % of the participants never used a condom during the preceding 12 months. Most of the participants said that reason for their use or non-use was based on partner evaluation. However, our participants indicate that there often is a deeper reason why they do not use condoms. Women talk about their male partner’s resistance against condom use. Men in the other hand mention the problem with fit and feel especially problems related to erection problems when they have been drinking alcohol. One of the most interesting findings is that the participants’ view of sex affected their condom use. Those with a relaxed view (e.g., did not connect love with sex and had had more sexual partners during the past 12 months) had fewer occasions of unprotected vaginal intercourse compared with the participants with a traditional view (e.g., often associated sex with vaginal penetration).The most important thing we need to do is increase ’men’s sense of responsibility and involve them in the prevention work. It is also important that the condom counseling is individualized. It is not enough to simply speak about condom use in general; instead we need to relate condom use to sexual practice and partner type but also to the individuals’ specific condom problem. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Epub ahead of print. Paper 2: Manuscript. Paper 3: Manuscript.</p>

In Ethiopia the number of young people going to college is steadily increasing. This predisposes them to risky sexual behaviour which leads to unwanted pregnancy, unsafe abortions and HIV. This study has aimed to determine the patterns of sexual practice and contraceptives use and risk behaviours among those students in central Ethiopia. A descriptive cross-sectional survey was employed. Data on sexual practice, knowledge and contraceptive use were collected from 327 college students. The data were cleaned, entered and analysed using SPSS version 20. The results revealed that despite their knowledge of the methods of safe sex, there are still considerable misconceptions regarding the effectiveness of contraceptives, their side effects and their proper use. In terms of the sexual practice reported by the respondents, 142 (43.4%) practised sex and 110 (77.5%) of respondents had used contraceptives at least once. The age of the respondents, the number of years for which they stayed in college and their fields of study were significantly associated with their sexual practice. In conclusion, a significant number of college students practised sex without using contraceptives to prevent pregnancy, and a considerable number of their partners disapproved of the use of contraceptives / Health Studies / M.A. (Public Health)

This study investigated factors contributing to adolescent mothers' non-utilisation of contraceptives in the Piet Retief (Mkhondo) area. Contraceptives, emergency contraceptives and termination of pregnancy services are available free of charge. Nevertheless the number of adolescent mothers continues to increase in this area. Structured questionnaires were completed by 107 adolescent mothers. Most respondents (70,0%) received no sex education prior to their pregnancies, and were not knowledgeable about contraceptives. Subsequent to the birth of their babies, only 59,81% used contraceptives, risking further pregnancies. Adolescents, from the age of 12, should receive sex education. Availability of contraceptives during weekends could help adolescents to postpone their pregnancies. Health education should be given to the mothers in the Piet Retief (Mkhondo) area so that they can provide more effective sex education (including contraception) to their daughters. / Health Studies / M.A. (Health Studies)

<p>The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial. </p><p>Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).</p>

The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial. Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).

This study investigated factors contributing to adolescent mothers' non-utilisation of contraceptives in the Piet Retief (Mkhondo) area. Contraceptives, emergency contraceptives and termination of pregnancy services are available free of charge. Nevertheless the number of adolescent mothers continues to increase in this area. Structured questionnaires were completed by 107 adolescent mothers. Most respondents (70,0%) received no sex education prior to their pregnancies, and were not knowledgeable about contraceptives. Subsequent to the birth of their babies, only 59,81% used contraceptives, risking further pregnancies. Adolescents, from the age of 12, should receive sex education. Availability of contraceptives during weekends could help adolescents to postpone their pregnancies. Health education should be given to the mothers in the Piet Retief (Mkhondo) area so that they can provide more effective sex education (including contraception) to their daughters. / Health Studies / M.A. (Health Studies)

Ethiopia has one of the largest populations in the world, an estimate of 114 million inhabitants. With more than 40% of the population below the age of 15 the country has to make further progress in meeting its family planning needs. The fertility rate has slowly declined, but the population continues to grow. Efforts to reduce gender disparities and empower women have fallen short in many parts of the world. Evidence suggesting a link between women’s empowerment, health outcomes and health care service utilization. A secondary analysis of the 2016 Ethiopian Demographic and Health Survey was conducted. The aim of this study was to determine the association between women’s empowerment, sociodemographic and reproductive factors and contraceptive use among married women and women living with partner aged 15-49 in Ethiopia. Logistic regression, bivariate, and descriptive analysis was conducted. Decision-making role in regard to husband’s money was a strong predictor for contraceptive use. Women who alone or jointly made decision were more likely to use contraceptives. The state of wealth of women was a significant determinant for contraceptive use. Those with lower education were more likely to use contraceptives compared to those with higher education. Women who did not intend to have more children were more likely to use contraceptives. This study showed that contraceptive use is associated with women’s economic decision-making age, and several sociodemographic and reproductive factors. Improving women’s empowerment, through decision making power can improve contraceptive use and therefore achieve better maternal health.

Introduction:Rwanda is one of the countries in Sub-Saharan Africa with the most remarkable health achievements. However, Rwanda is still one of the countries with a high unmet need (34%) and high prevalence of unintended pregnancies. Objective: To examine the association between literacy and unmet need for contraception among women in reproductive age in Rwanda. Research design and methods: A cross-sectional study based on secondary data, derived from the Demographic and Health Survey (DHS) program. The study population was women in reproductive age (15- 49 years old) who lived in Rwanda. It included 13217 females out of the 13497 after the exclusion of females who are not residents of Rwanda, who are blind or visually impaired and who are need language card. The methodology involved cross tabulations, bivariate and multivariate logistic analyses. Results: There was a significant bivariate association between literacy and unmet need for contraception (OR=1.28; 95% CI 1.17-1.40; p &lt; .001), in which literate females where more likely to have an unmet need for contraception. There was no association between literacy and unmet need when controlling other factors. Others factors such as age, current marital status and province had a strong impact on the unmet need for contraception in the adjusted analysis. Conclusions: Literacy may be associated with the outcome, however, socio-economic factors have a stronger influence on the dependent variable. Regulations, policies and other features such as socio-cultural norms may differ from country to country, therefore it is important to consider the current situation of each country.

Jordan has a higher fertility rate (3.8) than the averages of countries similar in income to Jordan (2.2) and compared to the Middle East and North Africa region as a whole (2.8) (WHO, WB, UNICEF, & DHS, 2011). The findings of the 2009 Jordanian Population and Family Health Survey demonstrated that the total fertility rate (TFR) has stopped declining in the country since 2002 (DOS, 2010b; USAID, 2010). The prevalence of contraceptive use has also shown little change in Jordan over the last decade (DOS, 2010b; USAID, 2010). Given that contraception is one of the proximate determinants of fertility (Rahayu et al., 2009), the main purpose of this study was to investigate which factors are contributing to women's current contraceptive behavior and intention for future contraceptive use. Research questions were developed in a comprehensive framework that considers women's intention and actual behavior as outcomes of various interactive factors within a socio-cultural context. In particular, the study's framework was directed by a theoretical basis adapted from Ajzen and Fishbein's Theory of Reasoned Action (TRA) and an extensive review of the available literature in the research area. Obviously, the social set-up and cultural norms in the study setting, together with attitudes toward children and family, represent a traditional scenario that could help explain the consistency of fertility and contraceptive use in the country. Further, the influences of background characteristics on women's contraceptive behaviors and intentions provide another scenario that could help assess the current situation of family planning (FP) in Jordan. In this study, demographic factors, spousal communication variables and healthcare system-related factors are all defined as background characteristics. Attitudes and social norms reflect the women's behavioral determinants and represent the main constructs of the TRA. In fact, involving a set of factors related to women's beliefs and social norms in the study's framework provided an opportunity to explore how these factors might promote or inhibit a woman's intentions and behaviors in respect to contraceptive use. In a three-manuscript format, this research was designed to achieve a number of objectives. The first manuscript aimed at identifying the major factors associated with the current use of contraception among women of childbearing age in northern Jordan. The second manuscript focused on investigating the main factors that are associated with women's contraceptive method preference (e.g. the choice of modern contraceptives as effective methods in preventing pregnancy versus the choice of traditional contraceptives as methods with high failure rates). The third manuscript attempted to explore the key factors associated with women's intention for future contraceptive use since the existence of such an intention would consequently translate into an actual behavior later. In 2010, original cross-section data were collected by means of a face-to-face interview using a structured pre-tested survey. The study sample included women who were currently married and were between 18 and 49 years old. Applying a systematic random sampling procedure, all respondents were recruited from the waiting rooms of five randomly selected Maternal and Child Health (MCH) centers in the Governorate of Irbid, northern Jordan. Using a list provided by the Ministry of Health, all centers in the Governorate were stratified according to the region (urban vs. rural) and randomly selected in proportion to their number in each region. The final sample size for this research consisted of 536 women surveyed, giving a response rate of 92.4 percent. Utilizing logistic regression analyses, the results of the dissertation manuscripts indicate that women's behaviors and intentions toward the use of contraception are affected by a number of factors at the individual, familial and institutional levels. The findings that emerged from the three manuscripts provide health professionals and policy makers with important information to assist in the design of FP programs and campaigns aimed at increasing current contraceptive use, enhancing the adoption of modern contraception and motivating the intention for future contraceptive use. This research strongly suggests that health professionals develop health policies that both expand the availability of MCH centers and strengthen the role of healthcare providers to dispel the numerous rumors and misconceptions surrounding the use of contraceptives, particularly modern ones. Health workers at the MCH centers need to ensure that women have sufficient information about the benefits and side effects of different types of contraception by offering proper FP counseling. The messages that religious leaders can use in advocating for FP would also help make contraceptive use socially acceptable since their opinions are often followed by the majority. This would be a key step toward removing the barriers to contraceptive use. Moreover, to design effective FP interventions, planners should take into account women's attitudes toward the use of contraceptive methods and the components of those attitudes (e.g. women's approval of contraceptive use for birth spacing and perceptions regarding the value of large family sizes and the importance of having male children in Jordanian families). / Graduation date: 2012 / Access restricted to the OSU Community at author's request from May 9, 2012 - May 9, 2013