Several developing countries introduced family planning programs to reduce their population growth rates. The rapid spread of birth control programs in the developing countries was at times accompanied by measures which violated human rights. In response to the ethical violations and coercive policies on population control, toward the end of 1980s various international committees formulated a reproductive health approach to overcome the limited population control approach. Unlike other population control programs, the focus of reproductive health program is on “reproductive process,” where as the most immediate focus of family planning programs is on fertility. Although studies refer to reproductive health approach as an extension of fertility control approach, literature on reproductive health provides very few systematic approaches toward developing explanations of reproductive health. The current approaches on population control are influenced by the ideological shift towards a broad-based approach which involves fertility or family size as one of the components of reproductive health. The present study uses intermediate variables framework suggested by Davis and Blake to organize reproductive health explanations. The proposed framework suggests that the state of reproductive health is indicated by intercourse, conception, and gestation variables and assumes that reproductive health is a latent dimensional outcome indicated by the measures of the intermediate variables. Also, there is noticeable lack of studies on reproductive health in Muslim countries. Given this shortcoming in the literature on reproductive health, the proposed model on reproductive health is used to assess the reproductive health of women in Yemen. The data are from the Yemen Demographic and Maternal and Child Health Survey (YDMCHS) conducted in 1997. Structural equation analysis is used to analyze the data. It is found that gender power or women's empowerment is more influential than economic status in determining reproductive health outcomes. The results of the study provide support for the proposed model. Implications for social policy making are discussed.

Disorders of male reproductive health which manifest at birth (cryptorchidism, hypospadias) or in young adulthood (testicular germ cell cancer and low sperm counts), are common and may be increasing in incidence. These disorders have a common fetal origin and share risk factors; consequently they are hypothesized to comprise a testicular dysgenesis syndrome (TDS). TDS arises when maldevelopment (dysgenesis) of the fetal testis results in hormonal malfunctions and abnormal development and function of the somatic cells. It is thought that the suppressed intratesticular testosterone levels associated with TDS may account for subsequent low sperm counts, via a reduction in perinatal Sertoli cell proliferation/number. Sertoli cells do not express androgen receptors (AR) in fetal life in the human or rat, so it is hypothesised that any androgen effects on Sertoli cell number occur indirectly, via the AR positive peritubular myoid cells. Evidence from the di (n‐butyl) phthalate (DBP)‐treated rat model for TDS suggests that reduced androgen action may play a role in testicular dysgenesis as in patients with complete androgen insensitivity syndrome (CAIS; ‘testicular feminization’), in whom focal areas of testicular dysgenesis have been reported. The studies in this thesis sought to establish if reduced androgen levels/action in the fetal rat testis contribute to putative testicular dysgenetic features, namely reduced Sertoli cell number, occurrence of multinucleated gonocytes or abnormal aggregation of fetal Leydig cells, the precursor of focal dysgenesis. Pregnant rats were exposed to treatments or co‐treatments expected to manipulate testicular testosterone levels (DBP, testosterone propionate; TP) or action (flutamide, DMBA) or to induce intrauterine growth restriction (dexamethasone), another risk factor for TDS. The aforementioned endpoints were analysed in fetal testes and related to testicular testosterone levels and peripheral androgen action (anogenital distance). The same endpoints were evaluated in mice with inactivation of the androgen receptor (tfm or ARKO mice). As androgen action is assumed to be mediated indirectly, via the peritubular myoid cells, changes in peritubular myoid cell number and function were investigated in testes with suppressed androgens. In vitro studies were also used to investigate the role of androgens in Sertoli cell proliferation. Fetal rat testis explants were cultured with various chemicals designed to manipulate androgen action and Sertoli cell proliferation. Potential non‐androgen related mechanisms of DBP action were investigated using Taqman RT‐PCR to determine the mRNA expression of key developmental genes after exposure to DBP. Sertoli cell number was reduced after exposure to treatments that reduced testicular testosterone levels, i.e. DBP alone or as a co‐treatment, TP and dexamethasone. Sertoli cell numbers in ARKO mice were also significantly reduced. The occurrence of multinucleated gonocytes and large Leydig cell clusters were induced after exposure to DBP, alone or as a co‐treatment, but not after exposure to TP or dexamethasone, and these dysgenetic endpoints did not occur either in tfm or ARKO mice. Rats exposed in utero to DBP have reduced testicular testosterone levels, however peritubular myoid cell number was unaffected by DBP, though AR expression in the peritubular myoid cells was delayed, and laminin and vimentin expression in Sertoli cells was altered after DBP exposure. DMRT‐1 and DAX‐1 mRNA expression levels were significantly reduced after DBP exposure, but this reduction was no longer evident once mRNA expression was corrected for Sertoli cell number. In conclusion, these studies provide strong evidence that androgens play a role in regulation of Sertoli cell number/proliferation, and this is supported by a comparable reduction in Sertoli cell number in ARKO and tfm mice. However, since the treatments that reduce testicular testosterone in the rat, may also have a direct affect on the Sertoli cells, this alternate mechanism of action cannot be ruled out, and the administration of a treatment that reduces testicular testosterone without directly affecting Sertoli cells is required. These studies also show that reduced testicular testosterone levels are associated with multinucleated gonocyte formation and fetal Leydig cell aggregation, although this evidence it is not supported by parallel findings from the TP and dexamethasone exposed rats or the ARKO and tfm mice, as neither of these endpoints were identified as being affected in these animals. Aside from the delay in AR expression, there were no obvious changes in peritubular myoid cell number or the peritubular myoid cell markers examined in testes deprived of androgens, although there are other markers that could be investigated. mRNA analysis of the developmental genes investigated after DBP exposure, demonstrated no change in expression after correction for Sertoli cell number, suggesting that they do not play a role in the dysgenetic features observed in DBP exposed testes.

Outcome valuation and economic evaluation in maternal and reproductive health care can be complicated by the fact that: 1. Alternative interventions can be geared towards enhancing the experience of women undergoing care, rather than improving health status; and 2. Alternative interventions can directly affect the health and wellbeing of both woman and infant(s) This thesis explores methods for overcoming these challenges. A review of the literature indicates that: 1) while stated preference techniques have been used to value patient experience in the context of reproductive health care, few studies have incorporated such values into full economic evaluations; 2) while health state valuation techniques have been adapted to value combined mother-infant health outcomes, these techniques have never been used to value outcomes of alternative approaches to assisted reproduction; and 3) no economic evaluations in this area have explicitly considered preferences for the distribution of benefits between women and newborn infants. These gaps are addressed though three empirical case studies. The first demonstrates a method for measuring and incorporating women’s preferences for patient experience factors into an economic evaluation comparing alternative approaches to labour management. The second assesses women’s preferences for mother-infant health outcomes in the context of an economic evaluation comparing alternative approaches to IVF treatment. The final case study adopts an approach to estimate the relative monetary value that community members place on the prevention of maternal and neonatal deaths, in the context of decisions between competing health care programmes that impact differentially on these outcomes. The case studies show that the challenges identified above can be overcome by adapting one or other of the stated preference valuation techniques available to health economists. DCEs in particular offer a flexible approach to dealing with the complexities and trade-offs that can arise when considering choices between alternative reproductive health care interventions in the context of scarce resources.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Thesis (MPH) -- University of Limpopo, 2012. / Background: Youth friendly services were introduced in all the ten districts t of Lesotho to meet the adolescents health needs including reproductive health of adolescents. Despite this initiative there is still a high prevalence of teenage pregnancy and human immunodeficiency virus (HIV) infection among young people. Aim: The aim of the study was to investigate the utilization, and factors influencing the utilization of reproductive health services (RHS) among high school adolescents in Thaba-Tseka district of Lesotho. Methodology: This was a quantitative descriptive cross-sectional study. The study population was adolescents aged between 13 -19 years in the two high schools in the district. A total of 800 adolescents were asked to complete a structured, self-administered questionnaire. Descriptive statistics were used to summarise demographics, sexual activity, experience of sexually transmitted infections (STIs), and awareness and use of RHS. The chi-square test was used to identify associations between categorical variables, and binary logistical regression modelling was used to identify significant predictors of utilisation of RHS. Results: The response rate was 97.5% (780/800), but only 723 questionnaires had sufficient data to be analysed. The mean age of respondents was 16.4 years with a standard deviation of 1.7years. Of the respondents, 49.5% (358/723) had been sexually active with the youngest age at sexual debut of 8 years. Of these, 71.5% (256/358) were presently sexually active; 82.4% (295/358) had low overall levels of awareness of RHS; 37.9% (136/358) had ever visited the adolescent health corner (AHC); 34.9% (125/358) reported that there was a place that provided RHS in their local clinic; 57.3% (205/358) had ever used condoms; and 56.7% (203/358) had experienced a STI; Of those presently sexually active, 89.5% (229/256) used some form of contraceptive, with 95.2% (218/229) buying condoms from a retail shop although only 94.0% (205/218) reported using them, while 38.9% (89/229) also obtained them from the AHC. Only 13.3% (27/203) of those who had experienced signs of STI ever visited the AHC for treatment. Of those who knew about RHS, 54.4% (68/125) utilized the services. Statistically significant predictors of RHS utilization were having a friend using RHS (odds ratio [OR] =8.87; P value< 0.001) and access to RHS (OR=7.97; P < 0.001). Participants in higher grades were significantly less likely to use RHS compared to participants in lower grades (OR=0.21; P<0.001). Conclusion: Almost half of the adolescents engage in sexual activity at an early age and RHS are under-utilised, mostly because of lack of access. There is a need to embark on increasing accessibility of RHS among adolescents to promote utilization of RHS.

Syftet med studien var att jämföra effekterna mellan tidig eller uppskjuten oxytocinbehandling vid värksvaghet under förlossning samt att studera hur intaget av peroral vätska och/eller intravenös infusion kunde påverka förlossningsutfallet. Metod en prospektiv randomiserad kontrollerad studie där även jämförelse med kontrollgrupp utan oxytocinbehandling ingick. I studien ingick 351 förstföderskor med normal graviditet varav totalt 108 av kvinnorna kom att ingå i de två randomiserade grupperna. Datainsamling och analys gjordes på förlossningsutfallet för mor och barn. Resultatet visade på skillnad mellan grupperna tidig eller uppskjuten oxytocinbehandling vad gällde förlossningslängden. Tidig oxytocinbehandling innebar i genomsnitt två timmar kortare förlossning. I samma grupp ingick det fler barn som inte fått tidig hud mot hud kontakt med modern jämfört med den sent randomiserade gruppen. Det fanns också en tendens till att kvinnorna med tidig oxytocinbehandling hade fler förlossningar som avslutades instrumentellt. Vätskeintag under förlossning skilde sig åt mellan kontrollgruppen och de två randomiserade grupperna. Slutsatser. Värksvaghet hos kvinnor med förlängt öppningsskede orsakar fler instrumentella förlossningar och fler påverkade barn. Förlossningsförlopp med konstaterad värksvaghet förkortas med tidig tillförsel av oxytocin men med en tendens till försämrat utfall för mor och barn bl.a. genom ökat antal instrumentella förlossningar och fler påverkade barn. Längre förlossningsförlopp och värksvaghet inträffar i högre grad för kvinnor med epiduralbedövning. Kvinnors vätskeintag under förlossning tycks ha viss påverkan på förlossningsförlopp. Sökord: Oxytocin, delivery, labour, labor, childbirth, labour arrest, augmentation of labour, labour outcome, epidural / The objectives were to compare the effects between early or delayed augmentation with oxytocin during lack of progress in labour and to study the outcome of labour in relation to the intake of oral fluid and/or infusions. Method. The design of the study was a prospective randomized controlled trial where comparison with controls without oxytocin was included. Three hundred and fifty one low-risk nulliparous women were included in the study in which a total number of one hundred and eight were randomly allocated to either of the two randomized groups. Data were collected and analyzed in relation to the outcome of delivery for mother and child. The results showed a difference concerning the length of labour between the two groups early and delayed oxytocin treatment. In the randomized group of early oxytocin treatment the mean shortage of the length of labour was two hours. The same group there was a lager number of children without early skin-to-skin contact with the mother immediately after birth compared to the group with delayed augmentation. The results of the study also indicated a tendency towards a higher frequency of caesarean sections and instrumental vaginal deliveries in the group of women receiving early oxytocin treatment. The amount of fluid intake during delivery differed between the two randomized groups and the controls. Conclusions. Delays in the progress of labour result in a higher frequency of caesarean sections and instrumental deliveries and more affected children. Delays in the progress of labour are shortened with early treatment of oxytocin but with a tendency for less favourable outcome for the mother and the child due to increased number of caesarean sections and instrumental deliveries and more affected children. Lack of progress in labour occurs more often in women using epidural analgesia. Women’s fluid intake during delivery seems to affect the course of labour. Keywords: Oxytocin, delivery, labour, labor, childbirth, labour arrest, augmentation of labour, labour outcome, epidural

<p>Syftet med studien var att jämföra effekterna mellan tidig eller uppskjuten oxytocinbehandling vid värksvaghet under förlossning samt att studera hur intaget av peroral vätska och/eller intravenös infusion kunde påverka förlossningsutfallet.</p><p>Metod en prospektiv randomiserad kontrollerad studie där även jämförelse med kontrollgrupp utan oxytocinbehandling ingick. I studien ingick 351 förstföderskor med normal graviditet varav totalt 108 av kvinnorna kom att ingå i de två randomiserade grupperna. Datainsamling och analys gjordes på förlossningsutfallet för mor och barn.</p><p>Resultatet visade på skillnad mellan grupperna tidig eller uppskjuten oxytocinbehandling vad gällde förlossningslängden. Tidig oxytocinbehandling innebar i genomsnitt två timmar kortare förlossning. I samma grupp ingick det fler barn som inte fått tidig hud mot hud kontakt med modern jämfört med den sent randomiserade gruppen. Det fanns också en tendens till att kvinnorna med tidig oxytocinbehandling hade fler förlossningar som avslutades instrumentellt. Vätskeintag under förlossning skilde sig åt mellan kontrollgruppen och de två randomiserade grupperna.</p><p>Slutsatser. Värksvaghet hos kvinnor med förlängt öppningsskede orsakar fler instrumentella förlossningar och fler påverkade barn. Förlossningsförlopp med konstaterad värksvaghet förkortas med tidig tillförsel av oxytocin men med en tendens till försämrat utfall för mor och barn bl.a. genom ökat antal instrumentella förlossningar och fler påverkade barn. Längre förlossningsförlopp och värksvaghet inträffar i högre grad för kvinnor med epiduralbedövning. Kvinnors vätskeintag under förlossning tycks ha viss påverkan på förlossningsförlopp.</p><p>Sökord: Oxytocin, delivery, labour, labor, childbirth, labour arrest,</p><p>augmentation of labour, labour outcome, epidural</p> / <p>The objectives were to compare the effects between early or delayed augmentation with oxytocin during lack of progress in labour and to study the outcome of labour in relation to the intake of oral fluid and/or infusions.</p><p>Method. The design of the study was a prospective randomized controlled trial where comparison with controls without oxytocin was included. Three hundred and fifty one low-risk nulliparous women were included in the study in which a total number of one hundred and eight were randomly allocated to either of the two randomized groups. Data were collected and analyzed in relation to the outcome of delivery for mother and child.</p><p>The results showed a difference concerning the length of labour between the two groups early and delayed oxytocin treatment. In the randomized group of early oxytocin treatment the mean shortage of the length of labour was two hours. The same group there was a lager number of children without early skin-to-skin contact with the mother immediately after birth compared to the group with delayed augmentation. The results of the study also indicated a tendency towards a higher frequency of caesarean sections and instrumental vaginal deliveries in the group of women receiving early oxytocin treatment. The amount of fluid intake during delivery differed between the two randomized groups and the controls.</p><p>Conclusions. Delays in the progress of labour result in a higher frequency of caesarean sections and instrumental deliveries and more affected children. Delays in the progress of labour are shortened with early treatment of oxytocin but with a tendency for less favourable outcome for the mother and the child due to increased number of caesarean sections and instrumental deliveries and more affected children. Lack of progress in labour occurs more often in women using epidural analgesia. Women’s fluid intake during delivery seems to affect the course of labour.</p><p>Keywords: Oxytocin, delivery, labour, labor, childbirth, labour arrest, augmentation of labour, labour outcome, epidural</p>

Thesis (Ph.D.) -- University of Texas at Arlington, 2009.

Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xxiv, 271 p.; also includes graphics (some col.). Includes abstract and vita. Advisor: Ivy L. Pike, Dept. of Anthropology. Includes bibliographical references (p. 205-231).

Abortion upon request has been legal in Turkey since 1983. In 2012 the Prime Minister of Turkey announced his intent to restrict or ban abortion. The public protested in response and the Turkish government did not amend the abortion law. However, recent anecdotal evidence suggests that the provision of abortion in public hospitals has diminished significantly. The purpose of this qualitative study was to explore women’s experiences obtaining abortion care in Istanbul, Turkey. We also documented key informants’ perspectives about abortion and reproductive health service availability in Istanbul. According to women and key informants, abortion availability has decreased remarkably and is now only available in one public hospital in Istanbul. Abortion care remains available in the private sector but there are nonetheless barriers to obtaining timely abortion care in Turkey. To improve abortion services, future efforts should focus on re-integrating abortion services in the public sector and making medication abortion available to Turkish women.