This research examines the many different ethical issues that emerge in the health care setting with regards to prenatal diagnostic testing. Identifying the areas of clinical practice and religious counselling in need of improvements, particularly physician-client communication, is important to ensure that competent pregnant women make informed, considered choices about prenatal testing. This paper investigates the many factors that contribute to pregnant women's decision-making processes surrounding the acceptance or refusal of the maternal serum alpha-fetoprotein screen, ultrasonography, amniocentesis, chorionic villus sampling, and preimplantation diagnosis. Integrating scholarship in bioethics, religious studies, and the anthropological and sociological study of medicine, this dissertation offers a comparative analysis of religious attitudes toward prenatal diagnostic testing, describes the complexities of practical decision-making by pregnant women faced with genuine ethical dilemmas, and provides an analysis of ethical issues related to prenatal testing. This research will be of interest to scholars in religious studies and bioethics, prenatal genetic counsellors and obstetricians involved in the provision of prenatal diagnostic testing services, and specialists in women's health and reproductive decisionmaking.

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This retrospective study was undertaken to determine the effect of nutritional counseling and assessment of underweight pregnant women enrolled in NIP program of the Virginia State Health Department on pregnancy outcomes, including biological, social and nutritional risk variables. A total sample of 2228 prenatal women enrolled in the program from 1988-1991 were subjects for this study. A NIP program tracking form was used to obtain all the information pertinent to this research. About half of the underweight women as measured by percent expected weight remained underweight at their last visit and only 44% of the underweight pregnant women had normal expected weight at their last visit. Women of the other ethnic group had the highest change in protein intake during their pregnancy indicating that these women showed remarkable improvement in their dietary intake. The incidence of low birth weight in this subject population was greater when compared with the state vital statistics. Black women appeared to be more vulnerable than white women or women of other ethnic group. No significant difference was seen in the incidence of preterm and low birth weight infants born to underweight women who remained underweight at their last visit and those who had improvement in their percent expected weight. Longer NIP participation was not positively correlated with pregnancy outcomes. But positive correlations with number of nutritional visits and when the prenatal care began, it is possible that nutrition intervention by the NIP nutritionists may have reduced the incidence of unfavorable pregnancy outcomes. / Master of Science

South Africa is a very violent society, where violence is often used as a social resource to maintain control and establish authority. Global and local research suggests that there is a high prevalence of intimate partner violence (IPV), a facet of this violence, although little research has been conducted into the effects of IPV during pregnancy in the South African non-governmental organisation (NGO) context. NGOs globally and in South Africa have attempted to address IPV and IPV during pregnancy by providing services that aim to assist (largely female) clients emotionally and logistically. In light of this phenomenon, this qualitative study presents data generated through the use of a lightly-structured narrative interview schedule. The interviews were conducted over three sessions with eight counsellors, all based at two NGOs in South Africa and experienced in counselling women who have suffered IPV and IPV during pregnancy. This study used Taylor and Littleton’s (2006) narrative-discursive analytical lens, infused with theoretical insights from Foucault about power, discourse and narrative in order to identify the discursive resources that shape the narratives that the counsellors shared in the interviews and how these translate into subject positions and (gendered) power relations of the men and women about whom they speak. Six discursive resources emerged from the narratives, namely a discourse of ‘traditional “African” culture’, ‘patriarchal masculinity’, ‘nurturing femininity’, ‘female victimhood’, ‘female survivorhood’ and ‘human rights’. These informed the three main narratives that emerged: narratives about IPV in general, IPV during pregnancy, and the counsellors’ narratives about their intervention strategies. Within these narratives (and the micro-narratives which comprised them), men were largely positioned as subscribing to violent patriarchal behaviour whilst women were mostly positioned as nurturing and victims of this violence. The counsellors also constructed women as largely ignorant of their options about IPV and IPV during pregnancy; they constructed these phenomena as problems that require intervention and identified a number of factors that indicate what successful IPV interventions should entail. In reflecting upon this analysis, this study also aimed to address the questions of what is achieved or gained by using these narratives and discursive resources, what the significance or consequences are of constructing and using these particular narratives and discourses and whether different narratives or discourses would have been possible. Recommendations for further research includes incorporating more sites as well as interviewing perpetrators and IPV survivors themselves, perhaps in their home language where relevant rather than English, to gain a broader and more faceted understanding of the dynamics surrounding IPV during pregnancy. A recommendation for practice in intervention against IPV during pregnancy is to introduce more holistic/systemic intervention strategies and working with communities to address this issue.

Text in Afrikaans / Summaries in Afrikaans and English / Hierdie studie toon dat vroue wat vir terminasie van swangerskappe aanmeld, se behoeftes wyer as bloot die verwydering van die fetus strek. Die diversiteit van probleme, vra 'n beradingsbenadering wat holisties van aard is. Indien die sosiale, psigiese en spirituele behoeftes nie aangespreek word nie, het ons in die holistiese hantering gefaal. Die Department Huisartskunde waar ek werksaam is, beywer hom vir 'n holistiese benadering van die pasient. Hierdie benadering word ook deur die huidige SuidAfrikaanse Regering onderskryf. Die vrou met die ongewenste swangerskap het 'n behoefte om, behalwe die fisieke probleme, in totaliteit verstaan en gehoor te word. Sy smag na 'n berader wat saam met haar deur die kompleksiteit van die probleem kan dink en voel. Die holistiese benadering behels die fisieke sowel as die psigiese, maatskaplike en spirituele behoeftes. Die studie het te doen met 'n soeke na 'n beradingsbenadering wat in al die behoeftesvan die vrou sal voorsien. / This study demonstrates that the needs of women requesting a termination of pregnancy extend much further than the mere removal of the foetus. The diversity of problems demands a counselling approach that is holistic in nature. We will fail in this holistic management, should the social, psychological and spiritual needs not be addressed. The Department of Family Medicine where I am employed strives towards a holistic approach to the patient. This approach is also endorsed by the present South African Government. The woman with an unwanted pregnancy needs to be heard and understood in totality, over-and-above the physical problem. She yearns for a counsellor who can think and feel through the complexity of the problem together with her. The holistic approach includes the physical, as well as the psychological, social and spiritual aspects. The study involves a search for a counselling approach which provides for all these needs of the women. / Practical Theology / M.Th. (Praktiese Teologie - met spesialisering in Pastorale Terapie)

Text in Afrikaans / Summaries in Afrikaans and English / Hierdie studie toon dat vroue wat vir terminasie van swangerskappe aanmeld, se behoeftes wyer as bloot die verwydering van die fetus strek. Die diversiteit van probleme, vra 'n beradingsbenadering wat holisties van aard is. Indien die sosiale, psigiese en spirituele behoeftes nie aangespreek word nie, het ons in die holistiese hantering gefaal. Die Department Huisartskunde waar ek werksaam is, beywer hom vir 'n holistiese benadering van die pasient. Hierdie benadering word ook deur die huidige SuidAfrikaanse Regering onderskryf. Die vrou met die ongewenste swangerskap het 'n behoefte om, behalwe die fisieke probleme, in totaliteit verstaan en gehoor te word. Sy smag na 'n berader wat saam met haar deur die kompleksiteit van die probleem kan dink en voel. Die holistiese benadering behels die fisieke sowel as die psigiese, maatskaplike en spirituele behoeftes. Die studie het te doen met 'n soeke na 'n beradingsbenadering wat in al die behoeftesvan die vrou sal voorsien. / This study demonstrates that the needs of women requesting a termination of pregnancy extend much further than the mere removal of the foetus. The diversity of problems demands a counselling approach that is holistic in nature. We will fail in this holistic management, should the social, psychological and spiritual needs not be addressed. The Department of Family Medicine where I am employed strives towards a holistic approach to the patient. This approach is also endorsed by the present South African Government. The woman with an unwanted pregnancy needs to be heard and understood in totality, over-and-above the physical problem. She yearns for a counsellor who can think and feel through the complexity of the problem together with her. The holistic approach includes the physical, as well as the psychological, social and spiritual aspects. The study involves a search for a counselling approach which provides for all these needs of the women. / Philosophy, Practical and Systematic Theology / M.Th. (Praktiese Teologie - met spesialisering in Pastorale Terapie)