Philosophiae Doctor - PhD / Access to life-saving commodities and related services for women and children is a fundamental component of universal health coverage. However, countries confront numerous intractable challenges, such as aligning regulatory practices, enhancing health workforce capacity, and effectively managing supply chains, to ensure essential reproductive, maternal, newborn and child health (RMNCH) commodities and services reach all communities. To address these entrenched obstacles, the UN Commission on Life Saving Commodities for Women and Children (UNCoLSC) in 2012 outlined a series of recommendations to improve access to 13 low-cost and high-impact commodities. This thesis explores the improvements and remaining barriers to accessing life-saving commodities for women and children in sub-Saharan Africa and Southeast Asia. In addition, this thesis showcases how effective data-informed decision-making can support prioritized RMNCH investments and equitycentered action.

The objective of this study was to determine whether certain socio-cultural factors tend to influence family planning behavior and attitudes of certain married couples at Utah State University. Sociacultural factors considered in this study were: ethnic background, religious preference, level of education, and income. These sociocultural factors (independent variables) were examined from the standpoint of their influence upon one or more of the following dependent variables: the use or non-use of family planning, the extent to which family planning is used, attitude toward the most important source of information for family planning, and attitude regarding the single method which is considered to be best by respondents. The findings show that the socio-cultural variable Religious Preference was the main independent variable which proved to be significantly associated with the following dependent variables: sources of information for birth control (formal or informal); extent to which birth control is used (continually or periodically), and attitudes regarding the best method of birth control among women (artificial or nonartificial), Specifically, these findings show that the Catholics favored formal sources, while the Protestants favored informal sources of obtaining information about birth control. Catholics tended to use periodic methods of birth control , including rhythm, abstinence and non-use, while Protestants mainly used continual methods of birth control (primarily artificial). The last significant statistical difference showed the preference of Protestant women for artificial methods of birth control more than Catholic women. It was concluded that religion is still an important agent of socialization relating to birth control behavior and attitudes.

The prevalence of post abortion contraception in Zambia is lower than in many other African countries, with unmet family planning needs. Midwives play an important professional role in family planning. In conjunction with an abortion the midwife is provided with an opportunity to inform, discuss, prescribe and initiate family planning with the woman concerned. It is shown that women receiving information and knowledge about post abortion contraception are more likely to use it.   The aim of the study was to describe midwives experiences of working with post abortion family planning in Zambia.   A qualitative interview study with semi-structured questions was used. To conduct the study and find participants with the right inclusion criteria a strategic sampling was used. Ten midwives working with post abortion family planning in Zambia were interviewed. Qualitative content analysis was performed to analyze the collected data from the interviews.   During the data-analysis two categories and eight subcategories were identified. The midwives had experiences of several challenges within post abortion family planning. These included lack of knowledge, supplies and health care staff as well as problem with stigma around family planning and lack of compliance. The midwives also described other factors influencing the work with post abortion family planning. These factors included changes in attitudes, the midwife's knowledge and the importance of information provided by the midwives.   The midwives experienced that there were several factors influencing their work with post abortion family planning. Several challenges within post abortion family planning were identified in this study. Areas of improvement involve education, more midwives working and a better availability to post abortion family planning equipment and services. / Användandet av preventivmedel efter abort är lägre i Zambia i jämförelse med andra afrikanska länder och behovet av familjeplanering är inte tillfredsställt i Zambia. Barnmorskeprofessionen har en viktig roll i familjeplanering. I samband med abort har barnmorskan ett utmärkt tillfälle att informera, diskutera, förskriva samt initiera familjeplanering med den berörda kvinnan. Det har visat sig att kvinnor som får information och kunskap om familjeplanering efter abort är mer benägna att använda sig av preventivmedel.   Syftet med denna studie var att beskriva barnmorskors erfarenheter av att arbeta med familjeplanering för kvinnor i Zambia som genomgått en abort.   En kvalitativ intervjustudie med semistrukturerade frågor användes. För att nå deltagare som uppfyllde studiens inklusionskriterier användes ett strategiskt urval. Tio barnmorskor i Zambia som arbetar med familjeplanering efter abort deltog i studien. En kvalitativ innehållsanalys utfördes för att analysera det insamlade materialet.   Under analysen identifierades två kategorier och åtta subkategorier. Barnmorskorna hade erfarenhet av flera utmaningar inom familjeplanering efter abort. Dessa bestod dels av brist på kunskap, material och vårdpersonal samt problem med stigma kring familjeplanering och brist på följsamhet rörande preventivmedelsanvändning. Barnmorskorna beskrev även andra faktorer som påverkade arbetet med familjeplanering efter abort. Dessa faktorer bestod av ändrade attityder, barnmorskans kunskap och vikten av barnmorskans information.   Barnmorskorna hade erfarenhet av att flera faktorer påverkade deras arbete med familjeplanering efter abort. Flera utmaningar med familjeplanering efter abort identifierades genom den här studien. Förbättringsområden involverar utbildning, fler verksamma barnmorskor och en bättre tillgänglighet till material och familjeplanering efter abort.

Yes / This study aimed to determine the predictors of Knowledge, Attitude and Practice (KAP) towards Family Planning (FP) among pregnant Fijian women. A cross-sectional study was conducted over two months in 2019 with adult pregnant women attending the Antenatal Clinic (ANC) at Ba Mission Hospital (BMH), Fiji. Data was collected using a self-administrated questionnaire. Statistical analysis included correlation tests and regression analysis in determining predictors of KAP. 240 pregnant women participated in this study with a mean age of 26.02 (± SD = 4.13). The results showed a moderate level of knowledge (mean 14.95, SD ± 3.15), positive attitude (mean 20.56, SD ± 5.68), and good practice (mean 4.97, SD ± 1.73). Linear regression identified that women with more than seven children had a knowledge score of 3.65, lower than null parity (t value = -2.577, p = 0.011). Women aged 20 to 24 had a 6.47 lower attitude score than women aged 18 to 19 (t value = -2.142, p = 0.033). Women in defacto relationships had a 2.12 lower attitude score compared to the married category (t value = -2.128, p = 0.034). Fijian women of Indian descent had a 1.98 lower attitude score than the I Taukei women (t value = -2.639, p = 0.009). Women aged 30-34 had 2.41 lower practice scores than those aged 18-19 (t value = -2.462, p = 0.015). This study found a medium knowledge of FP among pregnant women. These findings support a recommendation for further research to implement effective strategies.

<p>Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services.</p>

<p>Background: About 22.4 million people were living with HIV/AIDS in 2008 out of which women constitute approximately 57%. Namibia is one of the highly affected countries with a national HIV prevalence of 17.8% among women attending antenatal clinics. Antiretroviral medications have become available in Namibia since 2002 and presently all district hospitals and some health centres provide ARVs to those in need. Namibia is rated as one of the few countries in sub-Sahara Africa with a high coverage of ART, with 80% of those in need of ART receiving the treatment. An increasing trend has been observed whereby HIV+ women on ARV are becoming pregnant. Little is known about the attitude, knowledge and behavior of these women towards family planning and use of contraceptives and what barriers they may be facing in accessing these services.Aim: To determine the factors affecting the utilization of family planning services by HIV+ pregnant women receiving PMTCT services. Methodology: The study was a cross sectional study using both quantitative and qualitative methods to assess the critical elements of knowledge, attitude and perceptions of the study participants towards family planning services. The study also assessed the health system and other factors that impact on the use of contraceptives by HIV+ women. It was conducted in northern Namibia at Oshakati Health centre among randomly selected pregnant HIV+ women attending for PMTCT services.Results: Among the 113 respondents, who participated in the study, 97.3% knew at least one method of family planning but only 53.6% actually used any method of contraception prior to current pregnancy. Among the 46.4% who did not use any contraception, the reasons often cited for non-use were because they wanted a baby (52%), spouse objection (10%), being afraid of the effects (14%) and other reasons such as belief, culture and distance to travel to the health facility. 88% of the respondents indicated a willingness to use contraceptives after current pregnancy and expressed general satisfaction with services at the health centre while asking for more information on family planning services.Conclusion: HIV+ women have high awareness on some contraceptives but use of contraceptives is not as high as many of them have a desire to have children for self esteem and leave a legacy for the future. Knowledge of the risks of pregnancy on HIV+ woman may be limited and there is a need to improve educational intervention in this regard as well as integrate family planning services into all HIV/AIDS services.</p>

This study aimed at identifying the socio-demographic and service related factors influencing intra uterine contraceptive device (IUD) utilization among family planning clients in Addis Ababa. With a quantitative, cross sectional descriptive design approach, data was collected using structured questionnaires administered by healthcare supervisors. A total of 366 family planning clients and 35 family planning service providers were interviewed. The findings indicated that the level of education, occupation, parity and fertility plan have significant (p<0.05) association with utilization of IUD. Healthcare service provider’s knowledge and skills for provision of intra uterine contraceptive device services were low. Community members lack awareness and knowledge of the benefit and side effects of the device. Therefore, community members need education to promote adherence and effective use of IUD. Similarly, healthcare service providers need skill training and education to ensure quality provision of IUD service / Health Studies / M.A. (Public Health)

This study aimed at identifying the socio-demographic and service related factors influencing intra uterine contraceptive device (IUD) utilization among family planning clients in Addis Ababa. With a quantitative, cross sectional descriptive design approach, data was collected using structured questionnaires administered by healthcare supervisors. A total of 366 family planning clients and 35 family planning service providers were interviewed. The findings indicated that the level of education, occupation, parity and fertility plan have significant (p<0.05) association with utilization of IUD. Healthcare service provider’s knowledge and skills for provision of intra uterine contraceptive device services were low. Community members lack awareness and knowledge of the benefit and side effects of the device. Therefore, community members need education to promote adherence and effective use of IUD. Similarly, healthcare service providers need skill training and education to ensure quality provision of IUD service / Health Studies / M.A. (Public Health)

This study was funded by a scholarship from the Swedish International Development Cooperation Agency (SIDA) as a Minor Field Study. The social economic development in Tanzania is a major challenge due to a continuing high rate of population growth. A growing   population   puts   increased   strain   on   healthcare,   food   supply   and   the environment.  Early childbearing limits women’s ability to educate themselves and contribute to society. The definition of family planning (FP) is to keep a sustainable population growth through reducing the family size. The government of Tanzania has developed  a  plan  for  FP,  which  includes  a  goal  that  60  percent  of  women  in reproductive age will use contraceptives in 2015. Healthcare professionals have a great potential to encourage lifestyles changes. It is therefore important to investigate the nurses’ experiences of teaching FP to increase the knowledge about their experiences. The aim of the study is to investigate nurses’ experiences of education about FP in the Rufiji district in Tanzania. This is a qualitative study and the data was collected through interviews using a semi structured open-ended question guide. The nurses’ experiences of teaching patients in FP concerns four different areas. Firstly, they have a variety of strategies to execute the education. Secondly, they describe what is necessary to create a meeting with the patient. Thirdly, the patients have needs that have to be met in a learning situation. Finally, even though it’s subtle, they empower the patient, which lays the foundation for making lifestyle changes. The key finding that the nurses spoke of as the  most  important  factor  when  teaching  is  the  importance  of  creating  a  good relationship with the patient.

ABSTRACT Background: The Rwandan government has set family planning (FP) as one of the goals and strategies to improve the health of the population. However, unmet needs for modern contraceptive methods are still a problem, as is the variance of modern contraceptive use among the five regions of Rwanda.   Aim: This study aimed at assessing key factors that contribute to the variance of modern contraceptive use between five regions of Rwanda. Methods: This study was a secondary analysis of the Rwanda Demographic health survey, 2010. A total of 492 clusters (urban/rural), composed by 12,792 households were selected in the survey; 13,790 women of reproductive age were systematically selected from selected households and interviewed about maternal and reproductive health issues. 6834 married women or living with their partners at the time of the survey were selected for this study. Results: Socio-economic and demographic characteristics of women, access to family planning (FP) information and women’s empowerment were associated with the variance of modern contraceptive use between the regions. Women’s empowerment was positively associated with modern contraceptive use in all regions. Access to information was associated with modern contraceptive use in all regions except in the North region (AOR: 1.24, 95%CI: O.8- 1.92). Conclusion: This study highlights that the variance of modern contraceptive use was associated to the way in which FP factors are associated with modern contraceptive use vary between regions and how different FP factors occur among regions. Further researches are needed to investigate potential factors on supply side that influence such variance.