Background. Unsafe abortions are a prominent problem in low and middle income countries. These unsafe abortions can be prevented by decreasing unintended pregnancy. Few adolescents in Uganda use contraception methods even though knowledge of various contraceptives are almost universal among women. Problems adolescents face are often multidimensional and require solutions as such. Health care providers’ perspective of these problems can be the difference for an adolescent to use or not use family planning services. Purpose. The aim of this study was to describe health care providers’ experiences and prospects of providing family planning to adolescents in Kampala, Uganda. Method. A semi-structured interview guide was used for face-to-face interviews. Eight participants from four organisations in Kampala, Uganda were interviewed. Qualitative content analysis method was used and the results were presented descriptively. Main results. The main result showed that the health care providers expressed that there is great importance to discuss and eradicate the myths and misconceptions the adolescents have regarding different family planning methods by sensitising with factual information, preferably in early ages. Some of the solutions to reach out as early as possible was to involve parents, social media and reproductive health-education in schools. The result presented an extensive description of their current methods in counseling and ways to reach adolescents, insight to various obstacles and ways to improve the pressing situation in Kampala, Uganda. Conclusion. The interviews aimed to explore health care providers’ experience of methods used for family planning to adolescents in Kampala, Uganda. The health care providers were aware of obstacles and potential improvements to develop their business further. To meet young people on their own conditions and to be adaptable was discussed as important for a successful family planning. / Bakgrund. Osäkra aborter är ett allvarligt problem i låg- och medelinkomstländer. Dessa aborter kan undvikas genom att minska oplanerade graviditeter. Få ungdomar i Uganda använder preventivmedel trots kunskapen om flera preventivmedel är nästan universell hos kvinnor. Problem ungdomar möter är multidimensionella och kräver liknande lösningar. Rådgivarens perspektiv på dessa problem kan vara avgörande för en ungdom att använda eller att inte använda preventivmedel. Syfte. Syftet med studien var att undersöka hälso- sjukvårdspersonalens erfarenhet och förhoppning av att erhålla familjeplanering till ungdomar i Kampala, Uganda. Metod. En semi-strukturerad intervjuguide användes för att utföra individuella intervjuer. Åtta deltagare från fyra organisationer i Kampala, Uganda, intervjuades. Kvalitativ innehållsanalys användes och resultatet presenterades deskriptivt. Resultat. Resultatet visade att hälso- sjukvårdsarbetarna uttryckte att det är väldigt viktigt att diskutera och förgöra de myter och missförstånd ungdomarna har angående olika preventivmedel genom att göra ungdomarna medvetna om vad som är fakta, gärna tidigt i åldrarna. Några av lösningarna att nå ut tidigast möjligt var att involvera föräldrar, sociala medier och utbildning om reproduktivhälsa i skolor. Resultatet visar en omfattande beskrivning av nuvarande metoder i rådgivning och sätt att nå ut till ungdomar, insikt i flera hinder och förslag på sätt att förbättra den pressade situationen i Kampala, Uganda. Slutsats. Intervjuernas mål var att undersöka hälso- sjukvårdspersonalens erfarenhet av metoder använda till familjeplanering till ungdomar i Kampala, Uganda. Hälso- sjukvårdspersonalen var medvetna om hinder och potentiella förbättringsarbeten som kan utveckla deras verksamhet ytterligare. Att möta ungdomarna på deras egna villkor och att vara anpassningsbar diskuterades som viktigt för en framgångsrik familjeplanering.

Since June of 2013, Plan B and its generics have been available over-the-counter without age restriction nationwide. Even so, pharmacy-based economic, physical, and staff-associated barriers still exist, potentially leading adolescent customers to fail to obtain emergency contraception (EC) in a sufficiently timely manner to prevent pregnancy. This study explores these pharmacy-based barriers to EC in the state of Kentucky focusing on comparisons of urban and non-urban pharmacies and chain and private pharmacies. Using a secret-shopper survey technique, the researcher called 220 Kentucky pharmacies acting as a 15-year-old girl seeking information about EC. Among other findings, a logistic regression analysis revealed that private pharmacies were 97% less likely to carry EC compared to chain pharmacies (OR= .027; p

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Health literacy is the degree to which individuals have the capacity to understand basic health information and services needed to make appropriate health decisions. Women seen at Maricopa Integrated Health System (MIHS) Refugee Women’s Health Clinic (RWHC) are routinely offered education on developing a Reproductive Life Plan (RLP). In order to influence women’s reproductive health and medical decision‐making, there is a need to tailor RLP counseling to engage their male partners in the refugee community. We aimed to assess increased knowledge on preconception care related to the importance of developing a RLP, perspectives on birth spacing, and the influence of men as well as religion in medical decision‐making. We aimed to identify the refugee community’s receptivity to culturally and linguistically appropriate audiovisual modalities. Study participants comprised 120 refugees (39 men and 81 women) including couples, across the respective target languages with pre‐ and post‐Likert scale surveys assessing perspectives on RLP, birth spacing, the role of religion, and readiness for behavior change. Summary statistics examined changes in pre‐ and post‐Likert scale survey responses with responses dichotomized as Strongly agree/Agree compared against all other responses. A higher frequency of male respondents agreed about knowing what RLP means in the posttest relative to pretest (71.8% to 89.7%, P = 0.016) as well as 'Not having children…' (41% to 64.1%, P=0.035). Female respondents were more likely to agree to 'Know what RLP means' (76.5% to 86.4%, P =0.039) and 'Having a baby soon after…' (65.4% to 76.5%, P =0.035) after the training. They also were less likely to agree that 'RLP is about birth control' (71.6% to 59.3%, P =0.021). Amongst Muslim participants, we found improvement in knowing what RLP means (65.5% to 87.9%) and that it is important for men to have a RLP (67.2% to 84.5%). Cronbach’s alpha was used to measure internal inconsistency, with most values less than 0.5 and deemed unacceptable. Only one value, birth spacing, was > 0.6 and deemed questionable. There was the same degree of concordance, yet there also was discordance in the direction of opinions between women and men pre vs post‐test answers. When comparing couples pre and posttest, there was no significant differences observed across genders. This is the first reported U.S. initiative to provide a culturally and linguistically appropriate preconception health education. Project had demonstrated ability to mobilize several ethnic communities around the RLP. Respondents among both genders were more likely to agree about knowing what RLP means. The most challenging aspect of our community mobilization efforts was recruiting a larger sample size. Another limitation was the use of the Likert scale in a population with low literacy as there were some discrepancies in responses to negatively‐worded questions. Future studies could use a visual analog scale of smiley faces to assist those with limited literacy and incorporate a more global feel.

In 1979, the Chinese government introduced the One-child Policy for the purpose of controlling population growth. Thirty years later, the fertility rate in China has declined to a very low level and one-child families have become the norm. At the same time, the consequences of low fertility rates have emerged. In 2015, the government announced a new policy that encouraged couples to have two children in order to raise the total fertility rate. In this paper, I analyze the economic and legal implications of the Chinese family planning policies. By examining to what extent fertility decisions are affected by government policies, I evaluate the potential effects of the Two-child Policy. The findings suggest that the Two-child Policy might not be effective in increasing the total fertility rate.

Unintended pregnancy (UP) is increasing among Latinos in the United States. Unintended pregnancy contributes to many negative consequences for infants, mothers and families. Concurrently, various factors affect Latino couples’ sexual relationship power, communication and decision making about family planning, including sexual relationship power, relationship commitment, dyadic adjustment, individual background, and cultural characteristics. Previous research has not focused on understanding the factors that affect Latino couples’ sexual relationship power, communication and sexual decision making from each partner’s perspective. The purpose of this study was to examine the association between sexual relationship power, communication, and sexual decision making from each partner’s perspective in relationship to family planning. In a cross-sectional design, recruited were a convenience sample of 40 Latino couples whose female partners in their second/third trimester from prenatal care clinics. Almost half of the participants were Mexican (males: 48%; females: 43%). The mean ages were 28 years (males, SD:5.67) and 26.5 years old (females, SD 4.81). Sample characteristics and partner responses were compared and contrasted. Machismo, perceived relationship commitment, relationship satisfaction and perceived decision making significantly contributed to the variance in sexual relationship power among women (F(8,26) = 6.776, p < 0.001). Increasing sexual relationship power through Latina empowerment and mutual decision making has the potential to build sustainable relationships. Relationship commitment, relationship satisfactions as well as cultural values (machismo and marianismo) were also the significant predictors for most of the study key variables. Decision making conversations among couples should optimally begin before the initiation of sexual activity and continue throughout the couples’ active sexual relationship. Couples communication facilitates making known each other’s will and thoughts and helps to promote healthy reproductive and sexual lives. Findings will contribute to developing targeted interventions to decrease UP while increasing quality of life for Latino families.

Introduction: Access to family planning services is a major public health issue. State policies and funding for family planning services may increase access to contraceptive services and help women avoid unintended pregnancies. Study Design: We identified sexually active, fertile women participants of the National Survey of Family Growth (2006-2008). Women were categorized as consistent or inconsistent users of contraceptives based on self-report. States were classified based on 2006 Medicaid family planning waiver status (income expansions, limited expansions, or no Medicaid family planning expansions), 2006 public funding for family planning in dollars per woman, and insurance coverage of contraceptive mandate status (comprehensive mandate, partial mandate, or no mandate). Multi-level logistic regression was used to estimate the extent to which state-level constructs increase consistent contraceptive use among reproductive aged women at risk of unintended pregnancy. Results: Women living in states with an Medicaid family planning income expansion waiver had 44% increased likelihood of consistent contraceptive use relative to women living in states with no Medicaid expansions (adjusted odds ratio (aOR): 1.44; 95% confidence interval (CI): 1.06-1.96). Limited Medicaid expansion was also associated with consistent contraceptive use (aOR: 1.30; 95% CI: 0.91-1.87). Nationwide a median of $86 (Interquartile range: $59-$133) of total public family planning funding was spent per woman in 2006. Higher levels of total public funding per woman for family planning services were not associated with an increase in the odds of consistent contraceptive use among all women (OR:1.05; 95% CI:0.98-1.12) or among women with incomes <250% of the federal poverty level (OR:1.06; 95%CI: 0.96-1.17). Comprehensive insurance coverage of contraceptives mandates increased the likelihood of consistent contraceptive use for privately insured women (aOR: 1.64; 95% CI: 1.08-2.50). Partial mandates were not associated with consistent contraceptive use. No association was observed among uninsured women (aOR: 0.77; 95%CI: 0.38-1.55). Conclusions: Comprehensive insurance mandates and income-based Medicaid eligibility expansions are associated with increased likelihood of consistent contraceptive use. More research is needed to understand the association between public funding for family planning and contraceptive use among women in need of publicly funded services.

Nearly half of all pregnancies in the United States are unintended. In 2002, the direct medical costs of unintended pregnancies were estimated to be almost five billion dollars. Moreover, women with unintended pregnancies tend to delay seeking prenatal care and making the necessary life style changes for the fetus. Subsequently, unintended pregnancies have the potential to lead to low birth weight infants and potentially poorer long-term child development. Although there are negative consequences with unintended pregnancies, repeat unintended pregnancies impose even greater health risks for both mothers and infants. To prevent unintended and repeat unintended pregnancies, family planning methods must be utilized effectively. Despite the potential risk associated with negative health outcomes of mothers and infants, repeated unintended pregnancies have not been studied extensively. Therefore, the purpose of this study was to examine the relationship between the number of unintended pregnancies and effective use of family planning methods. A secondary analysis of The National Statistics of Family Growth, cycle 6 (2002) was done. The study showed a statistically significant relationship association between the number of unintended pregnancies and effective contraceptive use after adjusting for confounders which include age, race, annual household income, marital status and types of insurance. The recommendation of this study include creating better strategies for family planning practices and the need to improving contraceptive education and service delivery for those with higher risk.

A narrative qualitative research design was used to understand the stories of young women diagnosed with BRCA1 and BRCA 2 genetic mutation. Four participants were selected who met the following criteria: (a) the participant is diagnosed with BRCA1 or BRCA2 genetic mutation, b) is within the age range of 18 to 35, (c) is without a cancer diagnosis, and is (d) not currently pregnant and does not have children. The four participants were interviewed through open-ended inquiry. The participants’ narratives proved both similar and dissimilar. The themes were organized into within-case narratives and across-case narratives. The narratives revealed that young BRCA previvors face unique challenges and experiences, and many can be viewed from an underlying feminist lens. In response to the research questions, BRCA previvors revealed detailed narratives, explored issues of family planning, and explained the ways in which BRCA has changed their worldviews.

Objetivo: descrever as características dos homens submetidos à vasectomia na rede pública do Município de Campinas, SP, e investigar a sua percepção quanto às conseqüências da esterilização em algumas áreas de sua vida e as relações entre as circunstâncias da cirurgia e essas conseqüências. Procedimentos metodológicos: estudo descritivo, com um componente qualitativo e outro quantitativo. Após a identificação dos sujeitos, eles foram contatados via telefone ou correio. Para a etapa qualitativa, se realizaram 10 entrevistas semi-estruturadas com homens selecionados de acordo com critérios propositais de escolaridade e número de filhos. Em seguida, foi aplicado um formulário estruturado a 202 homens, sorteados a partir da lista completa daqueles que haviam sido vasectomizados entre 1998 e 2004. As entrevistas semi-estruturadas foram transcritas e inseridas no programa The Ethnograph para desvelar as unidades de significado ou temas identificados. Os dados obtidos através dos formulários estruturados foram digitados através do módulo data entry do programa computacional SPSS. A análise dos dados quantitativos foi, inicialmente , descritiva, preparando-se tabelas com a distribuição de freqüências das principais variáveis estudas, de acordo com os objetivos definidos. Em seguida, foi avaliada a associação entre possíveis conseqüências da vasectomia e caracterísitcas dos homens e circunstâncias de vida em que a cirurgia foi realizada utilizando-se o teste qui-quadrado. Resultados: os resultados evidenciaram algumas mudanças no perfil dos homens que se submeteram à vasectomia com crescimento na porcentagem dos que tinham renda per capita até R$ 300,00: 47,6 por cento no período entre 1998-1999 e 61,3 por cento entre 2003 e 2004. Esse crescimento foi mais significativo entre os homens com menos de 35 anos de idade e que tinham dois ou mais filhos vivos na ocasião da cirurgia. A análise dos dados qualitativos revelou que os homens, em geral, consideravam que a decisão de submeter-se à vasectomia havia sido deles próprios e não admitiam influência de outras pessoas. Porém, ficou evidente que a decisão de operar-se só foi tomada diante do exemplo de pessoas significativas outros homens que testemunhavam da inocuidade do procedimento sobre a vida sexual. Essa decisão também, em geral, só foi tomada quando a esposa/companheira não podia mais usar outro método contraceptivo. Observou-se que 97 por cento estavam satisfeitos por terem feito a cirurgia e pouca referência a efeitos indesejados em distintas áreas de sua vida. Pouco mais da metade dos entrevistados atribuiu à vasectomia mudanças para melhor sobre sua saúde, corpo, relacionamento em geral com a família e situação econômica. Quase dois terços referiram-se a esse tipo de mudanças na vida sexual e no relacionamento em geral com a esposa. Prevaleceu a idéia de que a vasectomia só trouxera benefícios, principalmente maior tranqüilidade nas relações sexuais, sem medo de engravidar. Nas entrevistas semi-dirigidas a possibilidade de arrependimento foi mencionada como um potencial aspecto negativo da vasectomia, para a qual não havia solução na opinião dos entrevistados. Entre os poucos homens insatisfeitos com a vasectomia, apenas um havia feito a reversão da cirurgia porque vivia com uma nova companheira e queria ter filhos; entre os demais a insatisfação devia-se à dor provocada pelo procedimento cirúrgico. Conclusões: no contexto da regulamentação legal, o acesso à vasectomia parece facilitado aos homens com menor renda, mais jovens e com maior número de filhos, que optam pela cirurgia quando não vêem outra opção para regular a fecundidade do casal. Os homens tendem a intervir, na medida em que se percebem incapazes de cumprir seu papel de provedor da família. A possibilidade de fazer a vasectomia fica condicionada pelo acesso ao método e pelas informações sobre o mesmo, especialmente aquelas providas por pessoas significativas. O crescimento na busca pela vasectomia deve ser visto também de forma crítica: não apenas porque, necessariamente, não indica maior eqüidade nas relações de gênero, mas também porque segue testemunhando as deficiências de acesso ao planejamento familiar em nosso meio / Objective: to describe the characteristics of men who underwent vasectomy at the public service in Campinas, state of São Paulo and investigate their perception regarding the consequences of sterilization in some areas of their life, as well as the possible relationship between the circumstances of the surgery and these consequences. Methodology: A descriptive study including a qualitative and a quantitative component was carried out. Participants were contacted by telephone or by mail. For the qualitative phase semi-structured interviews were conducted with 10 men, selected according to purposeful sampling criteria concerning schooling and number of children; after that a pre-tested structured form was completed by 202 men, randomly chosen by lot from the complete list of those who had been vasectomized between 1998 and 2004. The semi-structured interviews were verbatim transcribed and the The Ethnograph program was used in the thematic analysis of content, for the identification thematic units or themes in the discourse of the participants. The data obtained through the structured forms were typed using the data entry module of the SPSS computer program. For the descriptive analysis tables were prepared with the frequency of the variables studied. Subsequently, the association among possible consequences of vasectomy, participants characteristics and the life circumstances in which the surgery performed were evaluated through the Chi-square test. Results: Some changes in the characteristics of man who underwent vasectomy were observed: an increase in the percentage of men sterilized who had per capita up to R$ 300,00 (three hunfred reais): that is, 47.6 per cent in the period of 1998-1999 and 61.3 per cent between 2003 and 2004. This increase was significant among the men who were less than 35 years old and had two or more live children at the moment of surgery. Analysis of the interviews showed. that men considered that the decision to undergo vasectomy was their own and did not report a great influence of other people. However, it became evident that the decision to perform the surgery was only made in face of the example of significant people other men who witnessed that the procedure was innocuous and had no adverse effect on their sexual life. This decision was usually only made when the wife/partner could no longer use another contraceptive method. Satisfaction with surgery (97 per cent ) and only a few reports of unwanted effects in different areas of their lives were observed. A little more than half of the interviewed participants mentioned positive changes on their health, body, relationship with the family and economic situation. About two thirds reported that these changes in their sexual lives and in the relationship with the wives.. The prevalent idea was that vasectomy brought benefits, mainly more tranquility in their sexual relationship without fear of pregnancy. In the semistructured interview the possibility to regret was mentioned as a potencial negative aspect of the vasectomy. It was mentioned for the participants as a problem without a solution. Among this few men not satisfied with the vasectomy, only one had done the reversion of the surgery because he had a new partner and they wanted more children, among the other the pain caused by the surgery procedures made them feel dissatisfaction. Conclusion: Considering the legal regulation context, the access to vasectomy seems to be facilitated for the men with low income, young and high number of children, who choose the vasectomy when they did not have another option to regulate the couple fertility. The men will act when they realize if the fertility was not interrupted they will unable to keep their role of family provider. The possibility to do vasectomy is conditioned by the access to the method and by the information about it, especially those provided by significative people. The increase in the number of men who choose vasectomy should be viewed critically not only because it does not indicate balance in the gender relation but also because the access to family planning presents some deficiencies in our environment

Rwanda experienced genocide from April to July 1994 during which over 800,000 people were murdered. Among the far-reaching changes that followed this event among individuals and in society overall, the Rwandan Demographic and Health Surveys (DHS) showed that contraceptive prevalence declined from 13% in 1992 to 4% in 2000 among married women of reproductive age. This dissertation has two hypotheses concerning Rwandan women's fertility preferences and behavior following the genocide. It is hypothesized that, first, high levels of conflict reduced women's desire for a child or for additional children and second, that women who experienced relatively high levels of conflict were more likely to act on their wish to not have a child or another child by using modern contraceptives than were women who experienced relatively low levels of conflict. The study's logistic regression dependent (outcome) variables were desire for a or another child and the use of modern contraceptives; the source for these data was the 2000 DHS. Three groups of independent variables were included: socio-demographic variables, also from the 2000 DHS, included age, number of living children, education level, urban/rural residence and socio-economic status; availability of family planning services, assessed using women's perception of distance as a barrier to obtaining health care for themselves, from the 2000 DHS, and quality of health services, assessed with data from the 2001 Service Provision Assessment; and experience of conflict, measured as the percentage of the 1994 commune populations that resided in refugee camps in 1995. Communes were considered `high migration' if 10 percent or more of their populations migrated to camps and `low migration' if less than 10 percent of their populations migrated to camps. Women who lived in high migration communes were considered to have relatively high experience of conflict and those who lived in low migration communes were consider dot have relatively low experience of conflict. Analysis showed that residents of high migration communes were significantly less likely to want a or another child as compared to residents of low migration communes (OR = .74); it appeared that the social environment of high migration had a dampening effect on desire for children. The analysis also showed that residents of high migration communes were significantly less likely to use a modern contraceptive method than were those of low migration communes (OR = .57), even though they were less likely to want a or another child and even when family planning services were reasonably available. The reasons for these results are unclear, and many factors may contribute. The generalized trauma experienced by the population may have had a numbing effect, in which taking action in any domain was difficult. Women may have felt pressured by society to have children as the society emerged from war, despite their own preferences. The population may also have distrusted government health facilities - the only source of services for most - in light of the interactions with officials during and after the genocide. However, another set of reasons specific to women and women's health may also have influenced the findings. There is a pervasive social stigma around reproductive health; these services have generally lagged behind other primary health care components. Moreover, rape was used as a weapon of war in the genocide; these experiences may have reduced women's willingness to seek reproductive health services specifically. Finally, the Rwandan genocide and its preparation were decidedly misogynistic; this pervasive dehumanization may have made it particularly difficult for women to seek care for their sexual and reproductive health needs and desires. This complex personal, social, physical and political context may explain why Rwandan women who may not have wanted a child or additional children nonetheless did not consistently act on their desires in the years following the 1994 genocide. The dissertation includes a series of essays providing the author's personal perspective on working in Rwanda in the 1980s and 1990s and being present in the country at the start of the genocide in April 1994.