The 2010 elections in Myanmar installed the country’s first civilian-elected government in more than 50 years, and subsequent growth and change have been rapid. However, reproductive health indicators are generally poor and reflect significant regional and geographic disparities. Rural populations are increasingly migrating to urban centers, like Yangon, in search of better economic opportunities and in response to persistent conflict. Many are settling in peri-urban Yangon, a dynamic series of townships characterized by poor infrastructure, slums, and a highly mobile population. However, very little is known about the reproductive health needs of this population. This study was designed to identify the reproductive health needs of women in peri-urban Yangon, and to understand better current practices, available services, and potential avenues for improvement. My research focused on delivery care, contraception, abortion, and post-abortion care. Using a multi-methods approach, and standard qualitative analytic techniques, I identified significant unmet reproductive health needs in peri-urban Yangon. The findings suggest that reproductive health services are often available but inaccessible. Findings demonstrate considerable misinformation, common and unsafe practices surrounding abortion and delivery, and a dearth of comprehensive sexual and reproductive health services for adolescent and unmarried populations.

In a study we conducted with Ontarian women about their abortion experiences (OAS), one third of participants expressed a desire for post-abortion support. Yet, there is some anecdotal evidence to suggest that organizations offering these services are using judgmental frameworks. In order to rigorously investigate this, we explored what post-abortion support services are offered across the province of Ontario. This multi-methods study included an analysis of OAS data, creating a directory of post-abortion support services in the province, conducting an analysis of how these services represent themselves online, and carrying out mystery client interactions. We found that the majority of organizations offering post-abortion support services in Ontario are crisis pregnancy centers. The services offered at these organizations are built upon frameworks that are both shaming and stigmatizing of abortion experiences. Efforts to increase the online visibility and overall accessibility of non-judgmental, medically accurate post-abortion support services in Ontario appear warranted.

The peri-coital contraceptive pill is a potential method for pregnancy prevention that could be taken in a period before or after unprotected sexual intercourse. However, uptake of a new contraceptive method relies on accessible terminology and frameworks with which to discuss it. I conducted seven focus group discussions across Canada to understand how women talk about different reproductive health technologies, explore the ways these discourses influence language and frameworks women use to talk about peri-coital contraceptives, and identify perceptions of and concerns about this potential method. Women thought the peri-coital contraceptive pill would be a valuable addition to current contraception. They disliked the name ”peri-coital”; although some participants created more resonant names related to unique aspects of this method, many found it challenging to clearly discuss the method with existing language for contraception. Concerted effort to develop terminology that is clearer may help facilitate the eventual introduction of this new contraceptive method in Canada and beyond.

La santé sexuelle et reproductive (SSR) est un enjeu préoccupant pour les femmes d’Afrique subsaharienne (ASS). Ces femmes sont les plus confrontées au VIH/SIDA, au manque de connaissances sur la SSR, aux ressources et services limités en matière de SSR et aux contraintes socioculturelles en matière de sexualité. Les femmes devenues relativement nombreuses dans l’immigration canadienne, plusieurs études soutiennent que la majorité d’entre elles tout comme les nouveaux arrivants, éprouvent des difficultés de navigation dans le système canadien de santé dues aux difficultés linguistiques, culturelles et aux connaissances limitées. Jusqu’à présent, peu d’études ont été faites auprès des femmes immigrantes d’ASS en tant qu’utilisatrices de services de SSR au Canada. Cette recherche vise à identifier les facteurs socioculturels qui influencent l’utilisation des services de SSR chez des femmes immigrantes francophones d’ASS d’Ottawa. Une approche qualitative exploratoire selon une perspective féministe a permis de répondre aux questions de recherche. Des entrevues individuelles auprès de douze femmes provenant d’ASS montrent que la culture est la principale toile de fond des facteurs prédisposants, habilitants, déclenchants et migratoires dans l’utilisation des services de SSR. Ce marquage culturel ancré dans l’éducation sexuelle, les connaissances, les croyances, les pratiques sur la sexualité et la reproduction influence la SSR des femmes. De plus, la maternité, déterminante tant pour la santé que pour l’identité de femme, fait de toute condition d’infertilité, une fatalité à résoudre en ASS. Enfin, un réseau social sélectif, homogène et culturel constitue une barrière considérable dans l’utilisation des services de SSR. Cette étude renforce l’importance pour les soins infirmiers, de considérer l’aspect culturel dans la prise en charge et la promotion de la SSR auprès des femmes immigrantes d’ASS.

Background: Infertility rates in the Middle East and North Africa are among the highest worldwide. Despite its elevated prevalence among men and women, infertility is mainly blamed on women’s reproductive health failures. Consequently, infertility threatens women’s social and marital security, social power, and status in society. In Canada, the Arab population constitutes the second largest group of newcomers, but very little research has explored Arab immigrant women’s experiences with and access to comprehensive reproductive health services. Objectives: This project aimed to fill a gap in the literature on reproductive health in Ontario. This study explored: 1) Arab women’s experiences with infertility and infertility-related services in Ontario; 2) the barriers these women face when seeking these services; and 3) possible ways infertility-related information and services could be improved. Methods: This qualitative study consisted of in-depth interviews with Arab immigrant women and interviews with key informants. We used a multi-modal recruitment strategy including social media ads, flyers, advertisements through community organizations, and an Arabic-language radiobroadcast. We analyzed both components for content and themes using deductive and inductive techniques. Results: Participants struggled with primary infertility, mainly due to polycystic ovarian syndrome or endometriosis. Women identified cost, socio-cultural dynamics, stigma, and embarrassment as barriers to seeking treatment. Women described existing services as lacking comprehensive information, cultural sensitivity, and emotional support. Conclusions: Our findings suggest that Arab immigrants face barriers in accessing infertility care in Ontario. These services can be improved through engaging in education and awareness raising efforts, providing psychosocial support services, and building bridges between organizations and the community.

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Modulation of the male reproductive system occurs as a result of exposure to endocrine disrupting compounds (EDCs) in different life stages. The effects of EDCs on the male reproductive system include infertility, decreased sperm count, function and morphology, abnormal development of secondary sex characteristics, reproductive function and sexual behavior, as well as decreased libido. Phytochemicals are naturally occurring, biologically active chemical compounds in plants. They are divided into different groups. Isoflavonoids and lignans, are the two major groups of phytoestrogens. Phytoestrogens of teas, coffee and buchu have many beneficial effects on body systems such as antimutagenic, antidiabetic, anti-inflammatory, antibacterial and antiviral properties. They also elicit many adverse events, for example, heavy consumption of green and black tea may cause liver damage and added unwanted effects when combined with other herbal beverages. Chronic heavy consumption of coffee is positively correlated to acute myocardial infarction and can elevate serum cholesterol levels. Rooibos tea decreases steroidogenesis by steroid secreting cell lines.This study investigated the effects of these beverages on the male reproductive system, using a minced testes method for determination of cell viability and hormone (testosterone) production. The first objective of this study was to optimize protein supplement for in vitro testosterone production using human serum albumin (HSA) and foetal bovine serum (FBS). Testicular cultures were prepared and exposed overnight to different concentrations of both sera and then incubated for 4 hours with or without luteinizing hormone (LH). The results showed that addition of protein supplements (HSA or FBS) did not have a significant effect on testosterone production. The second objective of this study was to investigate the effects of green tea, black tea, rooibos tea, coffee and buchu on cell viability of testicular cultures. Cells were treated overnight with varying concentrations of the plant extracts followed by incubation with/without LH for 4 hours. The effects of the plant beverages on cellular protein production were determined by the Bradford assay. The results showed that treatment of cells with varying concentrations of the plant extracts (with/without LH-treatment) had no significant effect on total cellular protein. The third objective of this study was to investigate the effects of black, green and rooibos teas, coffee and buchu on testosterone production by testicular cultures. The results obtained from these experiments showed that rooibos tea and buchu did not affect testosterone production in the presence or absence of LH. The results also indicated that green tea, black tea and coffee inhibited testosterone production by mouse testis cultures in the presence of LH, but not in the absence of LH. Black tea was the most potent inhibitor of testosterone synthesis by mouse testis cultures (IC50= 48 μg/ml), followed by coffee (IC50= 64 μg/ml) and green tea (IC50= 173 μg/ml). Green tea, black tea and coffee inhibited LH-stimulated testosterone synthesis, suggesting that these beverages may impair testicular steroidogenesis in mice. Thus, in spite of their acclaimed beneficial effects, consumption of these beverages in high doses raises concerns for their inhibitory effects on male reproductive function. Further in vitro and in vivo studies are warranted to determine their exact mechanisms of action on the male reproductive system in general and testicular function in particular.

Orientador: Joao Batista Alcantara Oliveira / Coorientador: Claudia Guilhermino Petersen / Banca: Mario Cavagna / Banca: Anice Maria Vieira de Camargo Martins / Resumo: Na reprodução assistida, a seleção de gametas com o objetivo de alcançar melhores resultados clínicos é uma tarefa crucial dos embriologistas. A qualidade do oócito é um fator chave na fertilidade feminina, refletindo o potencial intrínseco de desenvolvimento do gameta, além de ter um papel crucial não só na fecundação, mas também no desenvolvimento embrionário subsequente. Após a desnudação, consegue-se definir a maturidade oocitária, com a identificação do primeiro corpúsculo polar, além de permitir a avaliação da morfologia oocitária, analisando as características da zona pelúcida, do espaço perivitelino e do citoplasma. Os dismorfismos oocitários são classificados em 2 tipos: citoplasmáticos, que incluem a presença de granulações e/ou de inclusões citoplasmáticas (vacúolos, corpos refrativos, agregados do retículo endoplasmático) e extracitoplasmáticos (alterações na forma do oócito, alterações na zona pelúcida, no espaço perivitelino e alterações do corpúsculo polar). Essas variações na morfologia oocitária podem ocorrer devido a fatores como idade da mulher, problemas genéticos e alterações no ambiente hormonal a que o oócito é exposto com a hiperestimulação ovariana. A classificação da morfologia oocitária, bem como sua correlação com o desenvolvimento embrionário e taxa de gravidez são bastante controversas na literatura. Vários estudos não demonstram nenhuma associação entre os dismorfismos oocitários e os resultados da fertilização in vitro, enquanto outros relatam uma associação entre a morfologia oocitária e desenvolvimento embrionário. Essas diferenças nos resultados podem ser explicadas devido a utilização de diferentes critérios morfológicos e devido... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The selection of developmentally competent human gametes may increase the efficiency of assisted reproduction. Spermatozoa and oocytes are usually assessed according to morphologic criteria. Oocyte morphology can be affected by the age of the female, genetic aspects, and factors related to controlled ovarian stimulation. However, there is a lack of evidence in the literature concerning the effect of gonadotropin-releasing hormone (GnRH) analogues, either agonists or antagonists, on oocyte morphology. The aim of this randomized study was to investigate if the prevalence of oocyte dysmorphism is influenced by the type of pituitary suppression used in ovarian stimulation. A total of 64 patients at the first intracytoplasmic sperm injection (ICSI) cycle, were prospectively randomized to receive treatment with either a GnRH agonist with a long-term protocol (n: 32) or a GnRH antagonist with a multi-dose protocol (n: 32). Before being subjected to ICSI, the oocytes at metaphase II from both groups were morphologically analyzed under an inverted light microscope at a 400x magnification. The oocytes were classified as follows: normal or with cytoplasmic dysmorphism, extracytoplasmic dysmorphism, or both. The resulting measure was the detection of dysmorphic oocytes among the total number of oocytes analyzed. Out of a total of 681 oocytes, 189 (27.8%) were morphologically normal, 220 (32.3%) showed cytoplasmic dysmorphism, 124 (18.2%) showed extracytoplasmic alterations, and 148 (21.7%) exhibited both types of dysmorphisms. No significant difference was observed in oocyte dysmorphisms between the agonist- and antagonisttreated groups (P>0.05). Analysis for each dysmorphism revealed that the most common conditions were alterations in polar body shape (31.3%) and presence of diffuse cytoplasmic granulations (22.8%), refractile bodies (18.5%) and central cytoplasmic... (Complete abstract click access electronic below) / Mestre

To determine the effects of spaceflight on the mucin layer of uterine tubes, female mice were subjected to simulated microgravity and/or low dose rate radiation (LDR). Astronaut age-appropriate (6 months old), female C57BL/6 mice were exposed to anti-orthostatic tail suspension (AOS) for up 21 days to model the unloading, fluid shift, and physiological stress aspects of the microgravity component. Subsets of mice were also exposed to whole-body, gamma-irradiation (0.04Gy at 0.01cGy/h) using 57Co plates to simulate the LDR radiation component. Mice were then euthanized at 1, 4 or 9 months after the 21 day simulation. Tissues were harvested and quantitatively analyzed for mucin production by measuring the mucin layer thickness of the isthmus, ampulla, and infundibulum regions of the uterine tubes. Analyses conducted indicate that there were no significant reductions in the isthmus and ampulla sections across all treatment groups at the 1, 4, and 9 month time samples. The infundibulum section showed significant reductions at 4 and 9 months post treatment, but there was not a significant change in thickness at 1 month post treatment. These data indicate that both simulated microgravity and radiation exposure cause a thinning of the mucin layer in the infundibulum region of the uterine tube, but do not cause significant morphological changes in the isthmus and ampulla sections of the tube.

Background: HIV is a major and global public health issue. In 2014, approximately 17.4million women were living with HIV. Regarding HIV, there are socially acquiredprejudices that contributes to stigmatize those living with the infection. Women livingwith HIV are an extra vulnerable group in society, which can negatively affect theirhealth. Aim: To study the experiences of sexual and reproductive health in women livingwith an HIV diagnosis in the Western world. Method: A literature-based study. Themethod used for this study was based on qualitative research, which contribute a deeperunderstanding for a phenomenon. Eight articles were analyzed and resulted in three mainthemes and seven subthemes. Results: The results are presented under three main themes;To face new challenges, To be treated differently and Being emotionally affected. To facenew challenges describe women's experience in managing their sexuality and the needfor information. To be treated differently describes women's experience of beingstigmatized in society and in health care. Being emotionally affected describes howwomen experienced shame and fear, which contributed to the fact that women did notseek care during pregnancy. Conclusion: Women living with an HIV diagnosis are inneed of information as well as emotional and instrumental support. This need can beacknowledged when the nurse takes on the responsibility for nursing and applies personcentered care. / HIV är en viktig global folkhälsofråga. I slutet av 2018 levde 37,9 miljoner människormed HIV-diagnos. Flertalet gravida och ammande kvinnor behandlades ihälsobefrämjande syfte. HIV diagnosen kan bidra till att de som lever med infektionenriskerar att stigmatiseras. Kvinnor som lever med HIV är en extra utsatt och sårbar gruppi samhället, vilket kan påverka deras hälsa negativt. Sjuksköterskan ansvarar bland annatför att främja och återställa hälsa. I mötet med kvinnor som lever med en HIV-diagnos ärsjuksköterskan skyldig att utgå från den gemensamma värdegrund som återfinns i ICN:setiska kod. Åtta artiklar med kvalitativ ansats valdes ut för att belysa HIV-diagnostiseradekvinnors erfarenhet av sexualitet, graviditet och förlossning. Artiklarna resulterade i trehuvudteman; Att ställas inför nya utmaningar, Att bemötas annorlunda och Att varaemotionellt påverkad. Att ställas inför nya utmaningar innehåller tre underteman sombeskriver kvinnornas erfarenheter kring sexualitet, graviditet och förlossning. Deupplevde en osäkerhet kring sexualitet och graviditet som grundades i rädslan av att smittasin partner eller barn. Bristen på information bidrog till en osäkerhet. Trots kvinnornasosäkerhet hade de en längtan efter barn. Att bemötas annorlunda, med två underteman,skildrar de fördomar kvinnorna möter av hälso- och sjukvården samt omgivningen. Ivårdmötet kände sig kvinnorna annorlunda bemötta. Kvinnorna upplevde bristande stödpå grund av negativa antaganden från den sociala omgivningen. Slutligen visade Att varaemotionellt påverkad, med två underteman, att HIV-diagnosen gav upphov till emotionellpåverkan kring den sexuella och reproduktiva hälsan. Detta tog sig i uttryck som känslorav rädsla och skam. Rädslan innebar att bli avslöjad och avvisad som HIV-positiv.Känslan av skam bidrog till att kvinnorna inte uppsökte vård under graviditeten. Studiensresultat kan bidra till en ökad kunskap kring kvinnor som lever med en HIV-diagnos samtderas erfarenheter av sexualitet, graviditet och förlossning. Denna kunskap kan även bidratill att sjuksköterskor har en handlingsberedskap i vårdmötet med dessa kvinnor.Resultatet anses relevant oavsett vilket vårdsammahang som omger kvinnorna.

京都大学 / 0048 / 新制・課程博士 / 博士(人間・環境学) / 甲第21875号 / 人博第904号 / 新制||人||215(附属図書館) / 2018||人博||904(吉田南総合図書館) / 京都大学大学院人間・環境学研究科相関環境学専攻 / (主査)教授 瀬戸口 浩彰, 教授 加藤 眞, 教授 市岡 孝朗, 准教授 西川 完途 / 学位規則第4条第1項該当 / Doctor of Human and Environmental Studies / Kyoto University / DGAM