The significance of reproductive health and rights cannot be overemphasised. Investment in the rights of rural women, specifically their reproductive health rights, is a fundamental determinant of their empowerment and social development. Access to reproductive health services enables rural women to make informed choices in their reproductive lives. This is of paramount significance because the exercise of choice in one domain opens possibilities for choices in others. International and regional human rights treaties recognise the significance of reproductive health rights for women's wellbeing and survival and require that State Parties provide access to reproductive health services. Zimbabwe has ratified the relevant human rights treaties and has domesticated many of their provisions through the Constitution and other laws. Zimbabwe has obligations to respect, protect, promote and fulfil the right to reproductive health. Despite these obligations, rural women face a plethora of challenges in accessing reproductive health services, and their right to reproductive health continues to be infringed. The infringement is in violation of Zimbabwe's international and domestic human rights obligations. The purpose of this study was to examine and establish the challenges confronting rural women when accessing reproductive health care services in Hwange Rural District Zimbabwe. Using a phenomenology qualitative research design, data were gathered through structured face-to-face interviews with 20 women of reproductive age and five health care providers. Data from the field were bolstered with reviews of extant literature. Collected field data were thematically analysed and presented. The research findings revealed that although most of Zimbabwe's legislative, policy and institutional frameworks have provisions that comply with international obligations, the frameworks also contain restrictive provisions which perpetuate the challenges women face in accessing reproductive health care services. Furthermore, the human-rights compliant legislative and policy frameworks are often not properly implemented, thus leading to a violation of the right to reproductive health in practice. The study's empirical research revealed that in Hwange Rural District, women's capabilities to exercise their reproductive rights are limited by factors such as physical barriers like distance to the nearest health facility, availability of services, quality of care given at health facilities, poverty, religion and patriarchal tradition. A major challenge unearthed by the study was that rural women in Hwange District are not aware of their reproductive health rights. This lack of knowledge is disempowering because women who do not know their rights are not knowledgeable enough to demand their rights or defend them when violated. To redress the challenges faced by rural women, the study found that women can use judicial and extra judicial mechanisms ─ including the courts, human rights institutions, nongovernmental organisations, and civil society organisations ─ for litigation, exertion of political pressure, awareness raising and grassroots mobilisation. Such strategies are essential for ensuring that women hold the State accountable for violations of their reproductive rights. The study concludes that there is need to raise awareness on the right to reproductive health and the enacted laws and policies so as to equip women with the necessary information that will allow them to exercise their rights. It recommends that intensive human rights education programmes for both the formal and informal sector should be prioritised. It recommends the provision of adequate resourcing of various state institutions responsible for women's rights issues. Further, there should be a situational analysis of challenges faced by rural women in Zimbabwe based on the intricate factors of location within rural areas, religion, gender, human rights knowledge, culture and tradition. After such situational analysis, there is need to enact laws and policies that respond directly to the unique challenges faced by rural women, without using a ‘one size fits all' approach.

Decades of steel production and coking in the community of Sydney, Nova Scotia, have led to severe environmental insult. Increased amounts of air pollution from Sydney Steel Corporation and toxic emissions from the Muggah Creek Watershed have been well documented in several studies of the area since the 1960s. This research examines the potential impacts of exposure to hazardous waste on the reproductive health of women living in Cape Breton Regional Municipality through the following objectives: i) to assess the spatial pattern of various types of adverse reproductive events, plausibly linked to the environmental exposure of interest; ii) to determine if this pattern is related to proximity to the Tar Ponds/Coke Ovens site. To address the first objective, point pattern analysis was applied to observations from the Atlee Perinatal Database to determine if the observed pattern exhibited any clustering. To address the second objective, a multinomial logistic regression model was employed to determine if proximity to the Tar Ponds/Coke Ovens site was an important covariate of the adverse outcomes under study (preterm births, low birthweights, congenital anomalies and stillbirths). The results of the bivariate K-function indicated that there was weak global clustering for preterm births for two different time periods, while the ratio kernel estimates demonstrated that the patterns of the outcomes were non-random even after correcting for the underlying population distribution. The results of the multinomial logistic model demonstrated that variables pertaining to maternal characteristics, pregnancy history, current pregnancy maternal diagnoses, neonatal measures were important explanatory variables in the analysis. Place of residence was an important explanatory variable for preterm births and congenital anomalies. However, due to various limitations these results must be interpreted with caution. / Thesis / Master of Arts (MA)

Gender norms shape our sexual experiences because they provide us with information about the appropriate behavior for men and women in social interactions (Allgeier and McCormick, 1983). Family is one of the places where we first learn about gender norms. Research on youth sexuality shows the importance of family on the sexuality of individuals through paths such as parent-child communication, parents‟ gender attitudes, parental surveillance, etc. However, less is known about other practices in the family, such as gender dynamics, or gender role practices, that could also affect the sexuality of young individuals. The aim of this dissertation is to analyze whether the sexual division of decision-making power and labor (gender dynamics) in which vii youngsters were raised, have any effect on their age at sexual debut, and their use of condoms as a contraceptive method. The source of information is the National Survey of Youth 2000 for Mexico. A discrete time hazard model is used in the analysis of age at sexual debut and a logistic regression was performed to analyze condom use. Results show that egalitarian gender dynamics have effects that differ by socioeconomic status and gender. The most remarkable findings are that shared decision-making power decreases the likelihood of an early sexual debut among girls with low socioeconomic status, and increases the likelihood of condom use among girls with high socioeconomic status. / text

Thesis (MBA)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Providing quality primary healthcare services in a scarce resource environment in South Africa is a challenge. This is exacerbated by segments of the population experiencing high unemployment and extreme poverty leading to a prevalence of diseases such as HIV/Aids and Tuberculosis. Long queues and staff shortages have led to the Department of Health decentralising the primary healthcare system into district facilities, with the intention of offering greater access to equitable healthcare for all South Africans. Sexual reproductive health falls under the category of primary healthcare and is a specialised function, often carried out by inadequately trained providers using quota systems, who consider this essential service to be a low priority. The area of sexual reproductive health includes termination of pregnancy, contraception, treatment of sexually transmitted infections and cancer screening. Although termination of pregnancy is legal in South Africa, reluctance on the part of service providers to offer this service, due to conscientious objection has created a shortage of safe, legal healthcare facilities. In an effort to provide these life-saving services, non-governmental organisations are attempting to fill the service delivery shortfall. With the assistance of international donor funding, Marie Stopes South Africa has established a number of sexual reproductive healthcare facilities in townships in Gauteng and KwaZulu Natal. These services take place from basic structures located within communities most in need of healthcare, and offer a range of sexual reproductive health services at low cost to men and women of reproductive age. As the operational focus is on provision of services otherwise not available, the organisation has not measured the levels of customer satisfaction adequately to date. Due to the preventative and potentially life-saving nature of these services, improved customer satisfaction levels could, through word of mouth advertising and customer retention, increase the use of these facilities by community members, reduce numbers of unplanned pregnancies, and ultimately contribute to a decrease in the incidence of maternal mortality due to unsafe abortions. In this study, the SERVQUAL instrument will measure the gap between customer expectations prior to services received, and perceptions of the services post-delivery, in order to establish the current service quality gaps in township healthcare facilities. Management of the organisation will use this information to implement actions to improve customer satisfaction and monitor the impact of these actions, with the aim of increasing positive word-of-mouth advertising, leading to greater use of services and ultimately the long-term sustainability of the facilities.

This MA Thesis explores the effect of the armed conflict on modern contraceptive utilisation in Colombia, using a departmental random-effects logistic regression model on novel cross-sectional data from the Uppsala Peace and Conflict Database Georeferenced Event Data and the Colombian Demographic and Health Surveys from 2000, 2005 and 2010. Reproductive health and rights has enormous consequences for women’s lives, but their relationship to conflict in Colombia has barely been analysed. Exploring how armed conflict as context shape individual life choices such as family planning, the results showed that women in departments where conflict had occurred recently had significantly higher odds of using modern contraception on average than women in non-conflict. Women are likely more careful to avoid unwanted pregnancy because of increased impoverishment, insecurity, and emotional and physical stress of armed conflict. Conflict may also have reduced or more firmly decided their demand for children. Adding an interaction term between conflict and type of place of residence revealed that rural women in conflict departments were driving this finding, possibly due to the lack of access to abortion and post-abortion care in rural areas in Colombia.

Reproductive health patterns in post-Soviet Central Asian countries Abstract This study aims to evaluate reproductive health patterns among post-Soviet Central Asian republics since their independence. The reproductive health indicators of individual countries were researched and compared. Furthermore, cluster country groups among selected post-Soviet, post-Socialist and capitalist countries were identified based on certain reproductive health indicators for the beginning and the end of the research period. The subsequent research was focused on 1999 Kazakhstan Demographic and Health Survey data. This thesis explores statistically significant factors influencing pregnancy outcomes in the country. According to the results, never married, urban women, women of Ukrainian, Russian, and other ethnicities, women living in the East and North regions were more likely to terminate a first pregnancy by an induced abortion rather than giving a live birth. Additionally, the same categories were proven to be statistically significant using the Poisson regression analysis, except the regions were shown to be the West and the North. Keywords: post-Soviet Central Asia, reproductive health, maternal mortality, pregnancy outcomes

Contraceptive non-use by women has been linked to negative reproductive health outcomes such as obstetric complications, abortions, and maternal morbidity and mortality. These poor outcomes mostly arise from unintended pregnancies. With focus on married women non-users, this study examined the factors influencing non-use of contraception in Nigeria. The research identified a number of important characteristics which could predispose married women in Nigeria to non-use of contraceptive. Data from the 2008 Nigeria Demographic and Health Survey (NDHS) was utilized. The target population comprised all females aged 15-49 years who were interviewed and responded to questions on contraceptive use. The sample size was 23,954 which were made up of all married women in the country except for infecund, pregnant and sterilized women. The outcome variable was measured using current contraceptive use which was dichotomized: not using contraceptive coded as (1) and using contraceptive coded as (0). Logistic regression was used for the analysis. 20,983 married women (88% of the study population) reported that they are contraceptive non-users. Of these, the following characteristics of married women had higher odds of contraceptive non-use. Women who want more children within 2years, unsure of timing and undecided had higher odds (2.17) of contraceptive non-use, women who are 35 years and above (1.80), women who are from North West, North East and North Central (5.35, 2.95, 1.64, respectively), women who are Muslims (1.43) had higher odds of contraceptive non-use in Nigeria. The association remained statistically significant for women’s wealth index, number of living children, occupation, and place of residence, partner’s education and educational level of women. And all these were also observed to have effect on the non-use of contraceptive. Non-use of contraceptive among married women in Nigeria differs between women possibly because of region, religion, fertility intention, and age difference. These findings indicate areas that reproductive health policies and programmes should focus on in order to increase contraceptive uptake among married women in Nigeria. .

A research report submitted to the faculty of the Humanities at the University of Witwatersrand in partial fulfilment of the degree of Master of Arts in Demography and Population Studies, June 2017 / Background An estimated 2,000 women in Zambia suffer from obstetric fistula. Suggestions are that more women could be suffering from the same condition but do not report it due to fear of stigmatization. Incidences of obstetric fistula in Zambia may indicate that most pregnant women do not access the much-needed maternal health services, especially at the time of delivery. Therefore, understanding the factors that lead to obstetric fistula is vital for developing primary preventive interventions. This study estimated the prevalence and investigated the factors associated with obstetric fistula among women in Zambia. Methodology The study used data from the 2013-14 Zambia Demographic and Healthy Survey (ZDHS). A sample of 16,411 women aged 15-49 years old took part in the fistula module of the ZDHS. Descriptive and Complementary log-log regression model were conducted to assess the relationship between the covariates and obstetric fistula. Results The prevalence of obstetric fistula was estimated at 5.91 obstetric fistulas per 1000 women of reproductive ages. Age at first sex (AOR=0.86, CI: 0.77-0.97) and being in households of rich wealth status (AOR=0.36, CI: 0.14-0.79) were negatively associated with obstetric fistula. Conclusion Evidence suggest that in order to eradicate obstetric fistula in Zambia, there is need to implement interventions that will focus on improving the socioeconomic, health status, reproductive status, access to health care and use of healthcare resources of women. / XL2018

This thesis investigates the role of masculinities on men’s sexual and reproductive health in Botswana. Botswana is currently in the throes of a severe heterosexually driven HIV/AIDS epidemic that has eroded some of the developmental gains the country had achieved since independence. A unique feature of Botswana’s HIV epidemic is the rapid and phenomenal increase in infection and prevalence rates in the face of good levels of knowledge of HIV prevention and an early and comprehensive HIV prevention strategy that guaranteed access to free HIV prevention and treatment services, including ARV treatment. The lack of effectiveness of the country’s HIV efforts and subsequent increase in infection rates have been blamed on men’s risky sexual behavior and lack of support of their partners’ decisions to utilize these services. In fact, quantitative studies on men’s sexual behavior and HIV such as the Botswana AIDS Impact Surveys show that men are less likely to use VCT services and more likely to engage in risky sexual behavior that increases risk of HIV infection to themselves and their partners. While studies provide the evidence that implicates men in the rapid growth Botswana’s HIV epidemic, the studies provide little or no explanation of factors that motivate men’s behavior in reproductive health. This lack of insights on factors that motivate men’s behavior leads to stereotypes about male promiscuity and may contribute to the lack of effectiveness of HIV prevention strategies. The current HIV epidemic has thus thrust heterosexual masculinities at the centre of HIV prevention efforts and provides an opportunity for research to interrogate the role of heterosexual masculinities in reproductive health, especially HIV transmission and prevention. The thesis employs qualitative data to provide in-depth appreciation of the prevalent masculine norms and beliefs and to highlight contextual factors and processes that shape and give rise to various masculinities. It further uses quantitative data to provide measures of levels of men’s masculine and gender role beliefs that may influence HIV prevention and transmission and to test the association between masculinities and men’s sexual and reproductive health attitudes and practices. The results show that men’s sense of identity is socially constructed, and revolves around the notion of superiority to women, independence and having and being in control of the family. However, men face many challenges to the realization of this masculine ideal. Men’s perceived difficulty or failure to live up to socially constructed Men, Masculinities and Sexual and Reproductive Health in Botswana vii notions of masculinities affects their experience of sexual and reproductive health programs, especially women’s empowerment and HIV prevention programs. By their nature, these programs tend to challenge men’s dominance of women’s decision on sexuality, and are therefore experienced as a threat to some men’s sense of identity. Quantitative results indicate an association between masculinities and sexual and reproductive health. While men’s sense of masculinities is not the overriding factor determining their sexual and reproductive health attitudes and practices, the results show a strong association traditional masculine beliefs and negative sexual and reproductive health beliefs and practices. However, there is also strong evidence that men and masculinities are responding to contextual factors, such as the HIV epidemic, which has become a specific stress on the local construction of masculinities. In focus group discussions, many men challenged traditional masculine norms, beliefs and practices that increase their vulnerability to HIV infection and those that either encourage or condone violence within intimate relationships. Significantly high proportions of men had positive attitudes towards HIV prevention programs. It is evident that now more than ever (and thanks to the HIV/AIDS epidemic) many men are ready to question the predominant masculine norms, beliefs and practices that increase their vulnerability to infection and disease. These voices of change represent a window of opportunity for research and programs can meaningfully engage with men and masculinities on issues of sexuality, gender roles, sexual and reproductive health and HIV/AIDS prevention and transmission. There is need for future research and interventions to move away from focusing exclusively on individual models of preventive health behaviors to more multilevel, cultural and contextual explanations. Taking account of multilevel, cultural and contextual factors that shape masculinities and men’s sense of identity will ensure increased effectiveness of sexual and reproductive health programs, especially HIV/AIDS prevention programs. On the other hand, failure to account for cultural and contextual factors that shape individuals’ behavior will only ensure that the shortcomings of such intervention program will continue to be blamed on the individual.

The purpose of the study was to explore and describe young people’s perceptions of access to sexual and reproductive health (SRH) services in Swaziland. The study provided insights into the SRH services currently available to the young people of Swaziland and reveals the opportunities that can be used to improve accessibility and utilisation of the current reproductive health services. The findings will inform policy-making and appropriate future interventions for young people’s sexual and reproductive needs and services. Data were collected through a descriptive exploratory study design. Colaizzi’s seven steps of data analysis were used. The study provides ample evidence that young people face sexual health risks that justify their need to access and utilise SRH services. The findings revealed that access to service is an important but complex element of quality care, as it determines whether a client gets to the service provider. / Health Studies / M.A. (Health Studies)