Abstract Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. The main features of the syndrome include menstrual irregularities and hyperandrogenism. In addition to symptoms related to fertility, some women also suffer from an unfavourable metabolic profile including impaired glucose tolerance, dyslipidaemia and low-grade chronic inflammation. In the present studies we aimed to investigate the role of age on adrenal and ovarian androgen secretion in 79 women with PCOS and 98 healthy women, with special focus on the menopause. Furthermore, we studied the effects of combined hormonal contraceptives (CHCs) administered orally, transdermally and vaginally (n=42, healthy women, 9 weeks) and atorvastatin treatment (n=28, women with PCOS, 6 months) on androgen levels and metabolic factors. Androgen secretion capacity was analysed by using adrenal and ovarian stimulation tests and glucose tolerance by using oral and intravenous glucose tolerance tests. Furthermore, chronic inflammation was assessed via assay of C-reactive protein and pentraxin-3. Basal and stimulated adrenal and ovarian androgen production was elevated and levels remained higher in women with PCOS compared with healthy women even after the menopause. Furthermore, women with PCOS presented with enhanced insulin resistance and chronic inflammation, which persisted beyond menopausal transition. During CHC treatment, the route of administration was insignificant, and all treatments impaired insulin sensitivity and increased chronic inflammation. In women with PCOS, treatment with atorvastatin improved chronic inflammation and the lipid profile as expected, but worsened glucose tolerance and did not affect testosterone levels. Regardless of strict exclusion criteria, where only relatively healthy women with PCOS were recruited, the results showed that enhanced androgen secretion and unfavourable metabolic alterations associated with PCOS persist through menopausal transition. The findings emphasize the importance of monitoring glucose metabolism during the use of CHCs, especially in women with known risks of type 2 diabetes. Atorvastatin treatment exacerbates insulin resistance in women with PCOS and therefore the treatment should only be considered after individual risk assessment of cardiovascular disease and not just because of PCOS. / Tiivistelmä Monirakkulainen munasarjaoireyhtymä (PCOS) on hedelmällisessä iässä olevien naisten yleisin hormonaalinen ongelma. Tyypillisiä PCOS:n oireita ovat munarakkuloiden epäsäännöllisestä kypsymisestä johtuvat kuukautiskierron häiriöt ja miessukuhormonien eli androgeenien liikatuotanto. Hedelmällisyyttä heikentävien oireiden lisäksi PCOS:än liittyy aineenvaihdunnan ongelmia, kuten heikentynyttä sokerinsietoa sekä taipumus rasva-aineenvaihdunnan häiriöihin ja krooniseen tulehdukseen. Tutkimuksessa selvitettiin ikääntymisen ja vaihdevuosien vaikutuksia lisämunuais- ja munasarjaperäiseen androgeenieritykseen 79 PCOS-naisella ja 98 terveellä naisella. Lisäksi tutkittiin eri yhdistelmäehkäisyvalmisteiden antoreittien (suu, iho, emätin) (n=42, terveet naiset, 9 viikkoa) ja atorvastatiinihoidon (n=28, PCOS-naiset, 6 kuukautta) vaikutuksia androgeenitasoihin ja aineenvaihdunnallisiin muuttujiin. Androgeenieritystä tutkittiin lisämunuaisten ja munasarjojen stimulaatiotesteillä ja sokeriaineenvaihdunnan muutoksia suun kautta ja suonensisäisesti tehtävillä sokerirasituskokeilla. Tulehduksellista tilaa mitattiin määrittämällä C-reaktiivisen proteiinin ja pentraksiini-3:n pitoisuuksia. Lisämunuaisten ja munasarjojen androgeenieritys oli PCOS-naisilla lisääntynyt terveisiin naisiin verrattuna, ja ero säilyi vaihdevuosi-iän jälkeen. PCOS-naisilla esiintyi myös enemmän heikentynyttä sokerinsietoa ja kroonista tulehdusta vielä vaihdevuosi-iän jälkeenkin. Hormonaalinen yhdistelmäehkäisy heikensi insuliiniherkkyyttä sekä pahensi pitkäaikaista tulehdusta annostelureitistä riippumatta. Atorvastatiinihoito puolestaan paransi pitkäaikaista tulehdusta sekä rasva-aineenvaihduntaa PCOS-naisilla, mutta huononsi sokerinsietoa ja insuliiniherkkyyttä eikä sillä ollut vaikutusta testosteronitasoihin. Koska poissulkukriteerit olivat tiukat, tutkimuksiin valikoitui varsin terveitä PCOS-naisia. Siitä huolimatta osoittautui, että PCOS:än liittyvä lisääntynyt androgeenituotanto sekä epäedulliset aineenvaihdunnan muutokset jatkuvat vielä vaihdevuosi-iän jälkeen. Hormonaalisen yhdistelmäehkäisyn käytön aikana olisi hyvä seurata sokeriaineenvaihdunnan muutoksia erityisesti niillä naisilla, joilla on kohonnut riski sairastua aikuistyypin diabetekseen. Atorvastatiinihoito huonontaa PCOS-naisilla insuliiniherkkyyttä, minkä vuoksi hoito tulisi aloittaa vain yksilöllisen riskiarvion perusteella.

Aim: The 1996 Choice on Termination of Pregnancy Act decriminalized abortion in South Africa and the South African Medicines Control Council in 2000 approved the dispensing of emergency contraceptive methods by pharmacists to women without a doctor's prescription. This legislation has been hailed as among the most progressive in the world with respect to women's reproductive justice. However the realisation of these rights in practice has not always met expectations in part due to medical practitioners' ethical objections to termination of pregnancy and the provision of related services. The aim of this study was to interpret the varying ways in which medical practitioners frame termination of pregnancy and emergency contraceptive services, their own professional identities and that of their patients/clients. Methods: Sample of 58 doctors and 59 pharmacists drawn from all nine provinces of South Africa. Data collected using an anonymous confidential internet-based self-administered questionnaire. Participants were randomly recruited from online listings of South African doctors and pharmacists practicing in both private and public sectors. Data were analysed using theoretically derived qualitative content analysis. Results: Participants drew on eight frames to justify their willingness or unwillingness to provide termination-of-pregnancy related services: the foetal life frame, the women's rights frame, the balancing frame, the social justice frame, the do no harm frame, the legal and professional obligation frame, the consequences frame and the moral absolutist frame. Conclusion: Health professionals' willingness or unwillingness to provide termination of pregnancy related services is highly dependent on how they frame or understand termination of pregnancy, and how they understand their own professional identities and those of their patients/clients.

Deterrents to family planning practices were investigated among Swazi women between 1999- 2001. A total of 171 adolescents, women and men participated in focus group interviews. Information obtained in this way served as a framework for designing structured interview schedules. The views of 205 women were investigated, concerning factors deterring them from using family planning practices by means of conducting face to face studied interviews. Qualitative data were analysed using the NU*DIST and for the quantitative data the SPPS computer programs were used respectively. The results revealed that socio-cultural deterrents to family planning included high cultural value of children determining women's social status, the lack of knowledge about contraceptives, women's dependence on their husbands' decisions concerning reproductive issues and inefficient family planning services. Recommendations included that specific adolescent reproductive health services should be instituted and that the policy on reproductive health for Swaziland be revised. Reproductive health issues should be addressed in the school curriculum. All Swazi men and women, both adolescents and adults, should be educated about contraceptives. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

The purpose of this study was to explore possible problems associated with pregnancy amongst student nurses in the Northern Province, and to determine whether their studies were adversely affected by their pregnancies. This study was designed as a quantitative, exploratory descriptive survey to look into the pregnancies of a specific group of students exploring their experiences in the classrooms and in the clinical areas. During 1998 data was collected by distributing questionnaires to ninety three pregnant . student nurses. Sixty-seven (71,0%) of student nurses fell pregnant because they lacked knowledge about contraceptives. Four-six (49,5%) of the respondents delayed seeking antenatal care, although they needed advice and support. Whilst fifty-eight (62,4%) of the respondents suffered from minor ailments such as tiredness, pre-eclampsia, early bleeding prior to three months pregnancy, and dizziness. Fifty-eight (62,4%) of the respondents encountered problems with their academic progress, as revealed by decreasing marks scored before, during, and after delivery. Student nurses would willingly avail themselves of guidance, advice and support during their pregnancies if they could access such services. / Advanced Nursing Science / M.A.(Nursing Science)

Deterrents to family planning practices were investigated among Swazi women between 1999- 2001. A total of 171 adolescents, women and men participated in focus group interviews. Information obtained in this way served as a framework for designing structured interview schedules. The views of 205 women were investigated, concerning factors deterring them from using family planning practices by means of conducting face to face studied interviews. Qualitative data were analysed using the NU*DIST and for the quantitative data the SPPS computer programs were used respectively. The results revealed that socio-cultural deterrents to family planning included high cultural value of children determining women's social status, the lack of knowledge about contraceptives, women's dependence on their husbands' decisions concerning reproductive issues and inefficient family planning services. Recommendations included that specific adolescent reproductive health services should be instituted and that the policy on reproductive health for Swaziland be revised. Reproductive health issues should be addressed in the school curriculum. All Swazi men and women, both adolescents and adults, should be educated about contraceptives. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

The purpose of this study was to explore possible problems associated with pregnancy amongst student nurses in the Northern Province, and to determine whether their studies were adversely affected by their pregnancies. This study was designed as a quantitative, exploratory descriptive survey to look into the pregnancies of a specific group of students exploring their experiences in the classrooms and in the clinical areas. During 1998 data was collected by distributing questionnaires to ninety three pregnant . student nurses. Sixty-seven (71,0%) of student nurses fell pregnant because they lacked knowledge about contraceptives. Four-six (49,5%) of the respondents delayed seeking antenatal care, although they needed advice and support. Whilst fifty-eight (62,4%) of the respondents suffered from minor ailments such as tiredness, pre-eclampsia, early bleeding prior to three months pregnancy, and dizziness. Fifty-eight (62,4%) of the respondents encountered problems with their academic progress, as revealed by decreasing marks scored before, during, and after delivery. Student nurses would willingly avail themselves of guidance, advice and support during their pregnancies if they could access such services. / Advanced Nursing Science / M.A.(Nursing Science)

Adolescents have become focal points of discussions and debates regarding sexuality and reproductive health matters. However, little research has been done particularly in South Africa to examine their knowledge concerning abortion and emergency contraception. Research indicates that a substantial proportion of adolescent pregnancies are unintended or unwanted. Abortion and emergency contraception are both time-sensitive services. Thus having accurate and comprehensive knowledge about both abortion and emergency contraception is pivotal, in the case of unintended or unwanted pregnancy or when engaging in unprotected sex or experiencing contraceptive failure that could lead to pregnancy. The 1994 International Conference on Population and Development (ICPD) defined reproductive health rights for both men and women as the right to "decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so" (p. 60). That is, men and women should "have the right to make decisions concerning their reproduction free of discrimination, violence and coercion" (ICPD, 1994, p.60). Based on these definitions, it is rather evident that comprehensive and accurate knowledge are at the core of one's ability to make an informed consent. This is confirmed by Adler's (1992, p. 289) definition of informed consent or choice "a) access to sufficient information b) understanding the information c) competence to evaluate potential consequences d) freedom to make a choice and e) the ability to make and express that choice". It is from this framework that this study emerged. The aim of this study was to examine adolescents' knowledge concerning abortion and emergency contraception. The participants were Grade 11 learners between the ages of 15-24 years from five different schools in the Buffalo City Municipality. A sample of 514 was achieved. Data were analysed using descriptive cross-tabulation, chi-square and qualitative methods where appropriate. The results revealed that most of the participants did not have sufficient accurate knowledge concerning the Choice on Termination of Pregnancy Act, consequences of legal abortion and emergency contraceptive pills to make informed decisions. Furthermore, data also revealed that the participants' schools playa role in their sexual activity, their knowledge about the Choice on Termination of Pregnancy Act and about emergency contraceptive pills. Although this method made it feasible for the researcher to make general assumptions, non-responses were one of the limitations of the study. Similar research in various municipalities/cities in and outside the Eastern Cape is recommended so as to increase further awareness concerning the level of knowledge that adolescents have about contraceptive pills particularly emergency contraceptive pills, the Choice on Termination of Pregnancy Act and abortion in general.

Many religious leaders in the early 1900s were afraid of the immoral associations and repercussions of birth control. The Catholic Church and some Protestants never accepted contraception, or accepted it much later, but many mainline Protestants leaders did change their tune dramatically between the years of 1920 and 1931. This investigation seeks to understand how Margaret Sanger was able to use her rhetoric to move her reform from the leftist outskirts and decadent, sexual connotations into the mainstream of family-friendly, morally virtuous, and even conservative religious approval. Securing the approval of religious leaders subsequently provided the impetus for legal and medical acceptance by the late-1930s. Margaret Sanger used conferences, speeches, articles, her magazine (Birth Control Review), and several books to reinforce her message as she pragmatically shifted from the radical left closer to the center and conservatives. She knew the power of the churches to influence their members, and since the United States population had undeniably a Judeo-Christian base, this power could be harnessed in order to achieve success for the birth control movement, among the conservative medical and political communities and the public at large. Despite the clear consensus against birth control by all mainline Christian churches in 1920, including Roman Catholics and Protestants alike, the decade that followed would bring about a great divide that would continue to widen in successive decades. Sanger put forward many arguments in her works, but the ones which ultimately brought along the relatively conservative religious leaders were those that presented birth control not as a gender equity issue, but rather as a morally constructive reform that had the power to save and strengthen marriages; lessen prostitution and promiscuity; protect the health of women; reduce abortions, infanticide, and infant mortality; and improve the quality of life for children and families. Initially, many conservatives and religious leaders associated the birth control movement with radicals, feminists, prostitutes, and promiscuous youth, and feared contraception would lead to immorality and the deterioration of the family. Without the threat of pregnancy, conservatives feared that youth and even married adults would seize the opportunity to have sex outside of marriage. Others worried the decreasing size of families was a sign of growing selfishness and materialism. In response, Sanger promoted the movement as a way for conservatives to stop the rising divorce rates by strengthening and increasing marriages, and to improve the lives of families by humanely increasing the health and standard of living, for women and children especially. In short, she argued that birth control would not lead to deleterious consequences, but would actually improve family moral values and become an effective humanitarian reform. She recognized that both liberals and conservatives were united in hoping to strengthen the family, and so she emphasized those virtues and actively courted those same conservative religious leaders that had previously shunned birth control and the movement. Throughout the 1920s, she emphasized the ways in which birth control could strengthen marriages and improve the quality of life of women and children, and she effectively won over the relatively conservative religious leaders that she needed to bring about the movement’s public, medical, and political progress.

Indiana University-Purdue University Indianapolis (IUPUI) / This thesis analyzes the relationship between Flanner House, an African American settlement house, and Planned Parenthood of Central Indiana to determine why Flanner House director Cleo Blackburn would not allow a birth control clinic to be established at the Herman G. Morgan Health Center in 1951. Juxtaposing the scholarship of African Americans and birth control with the historiography of black settlement houses leads to the conclusion that Blackburn’s refusal to add birth control to the health center’s services had little to do with the black Indianapolis community’s opinions on birth control; instead, Flanner House was confined by conservative limitations imposed on it by white funders and organizations. The thesis examines the success of Blackburn and Freeman B. Ransom, Indianapolis’s powerful black leaders, in working within the system of limitations to establish the Morgan Health Center in 1947. Ransom and Blackburn received monetary support from the United Fund, the Indianapolis Foundation, and the U.S. Children’s Bureau, which stationed one of its physicians, Walter H. Maddux, in Indianapolis. The Center also worked as a part of the Indianapolis City Board of Health’s public health program. These organizations and individuals did not support birth control at this time and would greatly influence Blackburn’s decision about providing contraceptives. In 1951, Planned Parenthood approached Blackburn about adding birth control to the services at Morgan Health Center. Blackburn refused, citing the Catholic influence on the Flanner House board. While acknowledging the anti-birth control stance of Indianapolis Catholics, the thesis focuses on other factors that contributed to Blackburn’s decision and argues that the position of Flanner House as a black organization funded by conservative white organizations had more impact than any religious sentiment; birth control would have been a liability for the Morgan Health Center as adding contraceptives could have threatened the funding the Center needed in order to serve the African American community. Finally, the position of Planned Parenthood and Flanner House as subordinate organizations operating within the limitations of Indianapolis society are compared and found to be similar.

This study identified pregnancy-related challenges encountered by student nurses at SAMHS Nursing College, with an aim of identify factors contributing to student nurses' pregnancies as well as finding ways to deal and minimize the rate of the pregnancies amongst the student nurses. Thirty (30) structured interviews were conducted with student nurses who were pregnant and those who delivered their babies during the period 2002 to 2007. It has been revealed that ignorance is the major contributing factor for student nurses' pregnancies, 63% of the pregnancies were not planned, 52% of the respondents related their pregnancies to risk taking as they engaged in unprotected sex without the use of contraceptives, and thus it was concluded that student nurses are engaging themselves in risk behaviours and also engaging in unsafe sexual practices. The study also found that student nurses face physical, social, emotional as well as academic problems during pregnancy and after the delivery of their babies. Student nurses should be encouraged to use condoms and other methods of contraception, coupled with educating them on life skills, provision of recreational facilities; provision of counseling and support services may be the tool to minimise the unplanned pregnancies. / Health Studies / (M.A.(Public Health ))