Master of Public Health - MPH / 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. / South Africa

Adolescent fertility is a problem that is urgent in developing countries due to rapid population growth rates. To gain a better understanding of adolescent fertility within developing countries a study was undertaken to examine adolescent sexual behavior among teens within a developing country, Zambia. A self-administered questionnaire was given to secondary school going teenage women in Zambia. The sample population consisted of 503 women between the ages of 12 and 19. The survey was analyzed using both regression and univariate analysis of the data. The findings revealed that a high percentage of the teens have initiated sexual activity; yet few (4.2%) have ever used modern contraceptive methods. Suggestions were made for family planning programs that would involve both parents and their children.

Understanding the history of the Israeli-Palestinian conflict is important for a greater understanding of the current state of sexual and reproductive rights of Palestinian women. Constant military occupation has been a determining factor hindering the development of comprehensive and coherent health policies and programmes. As a result of the Oslo Accords and the Israeli-Palestinian Interim Agreement in 1994, the Palestinian National Authority was granted limited authority over portions of the West Bank and Gaza. In 2007-2008 a multi-national, multi-disciplinary study team undertook a national study to assess the reproductive health content of nursing education and identify gaps in curricular coverage and implementation. One component of this project included exploring final year nursing and midwifery students’ attitudes toward a range of sexual and reproductive health issues. This thesis analyzes these data and explores the demographic factors, including gender, region, and residence, associated with nursing and midwifery students’ attitudes toward abortion and contraception-related laws and policies. Our findings suggest that there is a considerable need to incorporate values clarification exercises as well as structured sessions dedicated to laws and policies governing sexual and reproductive health into the formal curricula of programs in both the West Bank and the Gaza Strip. Our results also shed further light on the dynamics shaping abortion and contraception attitudes among health professions students in the Occupied Palestinian Territories.

This thesis focuses on integration of family planning into development programmes. It aims to recommend most appropriate ways that non-governmental organizations can adopt in order to introduce family planning as a cross-cutting issue in their development programmes in rural regions of Ethiopia. This is to ensure that women and men have the possibility to make free and informed choices on their childbearing preferences and exercise family planning. In order to identify the most suitable approaches, methods and strategies for family planning mainstreaming, the thesis determines the most significant determinants and factors that affect the childbearing preferences and identify those that can be addressed by family planning mainstreaming. The thesis bases its theoretical framework on the Amartya Sen's Capabilites approach to human development. The second part of the thesis is dedicated to Ethiopia Case Study.

It takes two to tango! However, family planning programmes in most countries especially in Sub-Saharan Africa have focused almost solely on one - the female-invariably with little impact. The few attempts which have been made to involve males have concentrated on the adult male. It was felt the time had come to involve the adolescent males most of whom are already sexually active and after all are the husbands and fathers of tomorrow. Male high school students (N=240) out of a total of 2101 male students were randomly selected from all the six urban high schools in the Zwelitsha District of Ciskei (now part of the new Eastern Cape Province of RSA) and were surveyed to obtain information on KABP concerning family planning. The study was undertaken to provide information for planning of a family planning health intervention programme by the school health team in an attempt to address the high unplanned teenage pregnancy rate and STDs in the schools. The response rate was 83,3%. Important findings included the following: 90% reported they had already had sexual intercourse; the mean age at first sexual intercourse was 15.4 years; the interval from first intercourse to first contraceptive use was 2 years; knowledge of contraceptives was at times scanty and there were several misconceptions and myths concerning fertility, contraceptives and STDs; majority (71,5%) felt the decision to use contraceptives should be the responsibility of both male and female; 86,4% expressed the desire to use contraceptives in the future and 73,0% felt sex education should start in primary school. The adolescent male is interested in family planning and wants to be an active participant in the programme. Recommendations for improved family planning services in schools are made.

This study emphasizes the impact of family planning program components on contraceptive prevalence in less industrialized countries. Building on Lapham and Mauldin's "Program Effort and Fertility Decline" framework and policy evaluation's theory, the author developed two models to examine the impact of family planning programs on contraceptive prevalence and fertility under the constraints of socioeconomic development and demand for family planning. The study employed path analysis and multiple regression on data from the 1982 program effort study in 94 less developed countries (LDCs) by Lapham and Mauldin and 98 LDCs of the 1989 program effort study by Mauldin and Ross. The results of data analyses for all data sets are consistent for the most part. Major findings are as follows: (1) A combination of program effort and socioeconomic development best explains the variation of contraceptive prevalence. (2) Among socioeconomic variables, female literacy exerts the strongest direct and indirect influences to increase contraceptive prevalence and indirect influence to decrease total fertility rate. (3) Christianity performs a significant role in reducing contraceptive prevalence. (4) Among program effort components, availability and accessibility for fertility-control supplies and services have the most influence on contraceptive prevalence. (5) When controlling for demand for family planning, female literacy and Christianity have expected and significant relationships with contraceptive prevalence. Availability and accessibility to fertility-control supplies and services exerts a positive and statistically significant impact on contraceptive prevalence. Demand for family planning has a positive and statistically significant effect on program variables, availability, and contraceptive prevalence. (6) There is a strong inverse relationship between contraceptive use and fertility. Demand for family planning, program effort, and socioeconomic development influence fertility through contraceptive prevalence. The findings of this study suggest that governments in LDCs should give priorities to increasing female education and availability of contraception to effectively reduce fertility.

This study examines a chosen set of prominent actors within family planning initiatives aimed toward the global South to find out if there are traces of “smart economics” within the framings of the initiatives. The smart economic framework has received critique for instrumentalising women and using gender equality as a tool rather than a goal. Researchers have found similar arguments within the family planning discourse and emphasised the potential harm these arguments lead to. By looking at the websites of six family planning actors, a content analysis is the chosen method. By examining the texts from the websites through categories invented from key elements of the smart economic framework, certain themes or the lack of these themes can be used to find traces of smart economics within the framings of family planning initiatives. The material from the chosen organisations is argued to influence the family planning discourse and is relevant to review. The results show that there are traces of a smart economic narrative within the framings of family planning initiatives. As previous research has pointed out, there is a lack of focus on men’s role in family planning. By using a smart economic narrative, the organisations working with family planning contribute to the discourse as well as the overall development discourse. By addressing the problems of using the smart economic framework, hopefully, the discourse can transform into being rights-based and not instrumental.

Master of Public Health - MPH / The problem of the unmet need for contraception continues to affect contraceptive uptake particularly the use of long-acting reversible contraceptives. Globally, Sub-Saharan Africa is reported to have the highest unmet contraceptive need. For example, nearly 50 % of married women of reproductive age, wanting to avoid pregnancy or plan when to have children, are reportedly not using contraception. More specifically, the prevalence of contraceptive use, in the Midlands Province of Zimbabwe where the Gweru District is situated, is estimated to be only 11%. This study examined the uptake of and reasons for use of different types of modern contraceptives; the factors influencing contraceptive use; discontinuation of use and non-use and reasons thereof for contraception and for long-acting reversible contraception in particular, amongst women in the Gweru district attending contraceptive services.

Unauthorized reproduction of this article is prohibited. Objective: The role of local health departments (LHDs) as a clinical service provider remains a salient topic of discussion. As local and state health departments continue to migrate away from clinical services, there is need to understand the impact on these transitions on access to care in a given community. The purpose of this study was to examine the impact of clinical capacity reductions in LHDs on receipt of annual family planning visits among South Carolina women. Design: A rolling panel of women eligible for Medicaid between 2001 and 2012 was created. Receipt of an annual visit for each year of Medicaid eligibility was tracked over time. A typology reflecting changes in county capacity for clinical services was used as the independent variable. We estimated multivariate generalized estimating equation models, which examined changes in population-averaged probabilities (marginal means) of annual family planning visits over time by level of county typology. Results: Approximately 325 269 unduplicated women were included in the panel, with 25.18% receiving an annual visit in a given year. On average, receipt of annual visits in counties with notable reductions in LHD clinical capacity tended to be fewer over time (-0.022; 95% CI [confidence interval],-0.028 to-0.017) as among counties with reduced capacity that included a specific clinic closing (-0.032; 95% CI,-0.037 to-0.028). However, the magnitude of observed differences between county typologies was relatively small. Conclusions: Evidence of service discontinuity was present. However, differences occurred later in the study period following the economic recession. Our findings suggest that counties that reduced capacity did not lose ground but were unable to meet increasing demand from the economic recession relative to those that did not reduce capacity even when closing a clinic. As LHDs discontinue or significantly reduced clinical services, fulfilling the assurance role is important for transitioning women to other sources of care.

Women's control over their fertility is vital for both their health and that of their children. Although family planning methods are available at most health facilities in the country, the service does not enable many Black South African women to control their fertility successfully. This inadequacy of the present service is demonstrated, by a high rate of teenage pregnancy and abortion. Based on anecdotal reports, one of the barriers to effective use of contraceptive methods seemed to be the competence and abilities of the providers. This qualitative study was done in clinics in a peri-urban township to explore the knowledge and problem-solving abilities of the nurses providing family planning services. The aim was to use the information so gained to improve family planning services in the area by preparing a set of guidelines for the management of specific clinical problems and making recommendations to service organisers. The study tape-recorded 18 actual nurse-patient interactions to get an idea of the clinical problems faced by the nurses. A consensus panel was used to derive a set of "ideal" answers to the clinical scenarios the nurses faced in the consultations and the nurses' and panels' responses were compared. A focus group discussion with the nurses was then conducted and their opinions and reasons for the differences explored. The results revealed a general malaise affecting the services in this area. There were significant differences in the nurses and panels' handling of the problems especially in the areas of counselling and advice. In addition, the nurses were found to be inappropriate providers of family planning as their scope of practice prevented them from examining patients. They were also unable to rule out pregnancy because there were no pregnancy test kits available in the clinics. The focus group discussions indicated that many of the nurses knew how to handle the problems and what advice to give. They claimed that work and time pressures prevented them from doing this. They also alleged that patients were the problem and never told the truth. Poor communication skills and attitudes towards patients were other barriers identified. Nurses spoke to their patients like children and were often rude. In addition, nurses counselled patients infrequently on the use of methods and the side effects to be expected. Patients were offered a choice of method rarely and health education when given, focused on morality and did not mention issues like safe sex and HIV/ AIDS. The manual of guidelines will only address the problem solving of the nurses. The study therefore concludes by making recommendations to the Directorate of Maternal, Child and Women' s Health to carefully evaluate the use of enrolled nurses as providers with full consideration given to the quality of care that can be provided by them. The resources available and the practices related to supervision and in-service training also need to be reviewed and prioritised. A recommendation is also made to the Provincial Human Resources Directorate to develop policies for improving staff attitudes towards service users and disciplinary procedures for staff who are rude to service users. Recommendations are also made to supervisors to review the present training course and introduce the problem-solving approach and respect for patient autonomy into it. The supervision is also recommended to be facilitative and on-site and the providers must be involved in the solving of problems. The emphasis of the service must change from patient turnover to effective contraceptive use to enable women in this area to have any meaningful control over their fertility.