Thesis (M.S.)--University of Wisconsin, School of Nursing, 1973. / eContent provider-neutral record in process. Description based on print version record.

Thesis (M.S.)--University of Michigan, 1980.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.Soc.Sc.)--University of Hong Kong, 1986. / Also available in print.

Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Across the UK the integration of historically divergent specialities of genitourinary medicine (GUM) and well-woman/family planning (WW/FP) has emerged as a modern approach to sexual and reproductive health care provision. Integration’s most visible form is the ‘one-stop shop’ (OSS), where a full range of services are brought together under one roof and wherein care is provided by comprehensively trained practitioners. To date, there exists only limited insights into stakeholder experiences of integrated clinics. Conducting ethnographically-informed research at one such purpose-built OSS over a 9 month period (2013-2014), I sought to redress this gap in knowledge. Accompanying 29 attendees along their journey through the clinic, my research offers a detailed examination of the extent to which experience is shaped by integration. Drawing upon literature at the confluence of medical sociology, social geography, and anthropology, including Gesler’s (1992) ‘geographic metaphor’ of the ‘therapeutic landscape’, the thesis puts forward two key arguments. First, I suggest that participants often reconstructed the clinic as aligned to their presenting need, for example, a ‘GUM clinic’, or a ‘family planning’ service. This finding, teased out over the course of the thesis, destabilises assumptions present in previous studies that integration be inevitably deterministic in shaping attendees’ experiences. Second, the thesis contributes to a gaps in literature relating to Gesler’s (1992) ‘therapeutic landscapes’ in three key ways. The first contribution is to show how affective landscapes matter, are significant, in the formation of experience in a novel setting – a transient, ‘walk-in’ clinic. The findings, further, point to the elevated import of the physical and symbolic landscapes in the case of the OSS - a place where there is little opportunity to cultivate therapeutic social relationships. Finally, the thesis speaks to the ways in which the affective landscapes of the clinic work to challenge, confirm or reshape attendees’ preconceptions and expectations of sexual health services. Together, these findings contribute to pre-existing accounts of the experience of integrated services by asking us to consider the influence of forces other than the integrated status of service delivery on attendee experiences of such sites. I argue that place should not be conceived as immutable but, rather, is subject to individual interpretations that are, themselves, the product of both situated and external contexts.

Philosophiae Doctor - PhD / Maternal mortality is one of the most important problems related to the reproductive health. This is why the reduction by three quarters of maternal mortality by 2015 has been fixed as target No. 5 of the Millennium Development Goals (MDGs). Achieving this goal requires an annual decline of 5.5% of maternal mortality between 1990 and 2015. Unfortunately, the reduction as estimated in 1997 was less than 1% per year. Africa is the continent most affected by this problem. In 2010, the number of maternal mortality in the world was estimated to 287 000 and Africa was hosting more than 52 % (148 000) of the occurrence in the world In Burkina Faso, maternal mortality ratio decreased from 566 in 1991 to 484 in 1998 and 341 in 2010 according to the DHS data while the census estimate was 307 in 2006 and United Nation agencies provided the number of 300 maternal deaths per 100 000 live births in 2010. Statistics provided by the different sources vary considerably. This situation creates confusion among data users. In addition, researches made on the issue remain very insufficient because of the complexity of the issue, lack of data and poor quality of existing data on maternal mortality. This study has been initiated to fill the gap of knowledge about the determinants and estimates of maternal mortality at national and sub-national levels. Results of this research highlighted explanatory factors of maternal mortality at national and regional level with a focus on factors of regional disparities. Findings also provided estimate by adjusting the census 2006 data from missingness and incoherences, improving the census method and testing different other methods. Finally, projection of maternal mortality level is made from 2006 to 2050.

Magister Public Health - MPH / South Africa

Burundi’s high maternal and child mortality is caused in part by the high fertility rate, prompted by low rate of contraceptive use. Available sources report a contraceptive use of 18% among married women, but this excludes unmarried sexually active women. This study employed mixed methods to understand rates of contraceptive use in rural Burundi. We first assessed availability and uptake of contraceptives in 39 health clinics in the rural districts of Rumonge and Bururi. We selected sites with different utilization rates and conducted individual interviews and focus group discussions. 56 individuals participated including women, men, facility managers and community leaders. Uptake of family planning averaged 2.96%. Greater uptake was positively associated with the number of health professionals engaged and trained in family planning service provision as well as the number of different types of contraceptives available. Uptake was inversely associated with duration of stockouts and number of contraceptives stocked out. Qualitative data pointed to scarce resources, sociocultural factors, fear of disclosure and side effects, partner’s disapproval, and lack of information on modern contraceptives as explanations of low uptake. Interventions would need to take into account one or more of these factors in order to improve uptake of family planning

Panic over human population growth became a near-global phenomenon in the second half of the twentieth century. International networks encouraged governments to adopt population control methodologies that used state power and national policy to incentivize, and sometimes coerce, lower fertility rates. By the end of the century, the failures and draconian nature of population control led to a rebuke of broad demographic interventions. Population policy shifted toward a reproductive rights framework that privileged individual prerogative over any national agenda. My research introduces a conceptual middle ground that allows for coordinated state programming in the face of undesirable demographic trajectories, while also upholding a spectrum of individual liberty – what I call “population management.” The model for population management is not hypothetical, but materialized in Tanzania during the Ujamaa era that lasted roughly two decades from 1967 to 1986. Through robust leadership, a sense of imagined kinship, moral nuance, and an active policymaking coalition, Tanzania nurtured an approach to changing demographics that centered population within its broader postcolonial development project. Population management encouraged reciprocal state and community action to assuage problems brought on by an increasing population, including education reforms, diversified family planning, and public health campaigns. The flexible concept of “responsible parenthood” kept varying groups of government actors, religious authorities, women’s organizations, community leaders, and health practitioners on the same page, as their multiplicity of lived experience helped define and inform policy. Tanzania’s population management agenda reframes the historical narrative away from a binary of state control versus individual rights, and provides a model for future policymaking. Combating the attendant problems of population change requires broad networks working together, which makes collaboration and flexibility key to maintaining collective action. As global demographic agendas diverge with rapid population growth in regions of Africa and depopulation in high-income countries, governments will need to adopt contextualized population policies that acknowledge unique historical, personal, and local sensitivities. / 2022-07-15T00:00:00Z