Thesis (M.A.)--Oregon State University, 2011. / Printout. Includes bibliographical references (leaves 113-120). Also available on the World Wide Web.

Ph.D. (Community Nursing Science) / The provision of reproductive health promotion services to females in South Africa is the responsibility of the national and provincial governments, while in primary healthcare (PHC) settings the local government is responsible for the provision of free reproductive health promotion services to females. The prevalence of sexually transmitted infections (STIs), the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) led to the development and provision of noncollaborated vertical PHC reproductive health programmes. The purpose of this study was to develop a model to collaborate the provision of reproductive health promotion services in PHC settings. A qualitative, descriptive phenomenological design, exploratory and descriptive approaches and contextual and theory generating design were used. The study was conducted in three phases. In phase 1, data collection consisted of individual indepth interviews and focus group interviews. Non-probability purposive sampling was used to include three population groups: females who utilised the reproductive health promotion services and reproductive health promotion service providers and those who provide clinical teaching regarding reproductive health promotion in two different PHC settings who were sampled through non-probability convenience sampling methods. Throughout the study, ethical principles were strictly adhered to and trustworthiness was ensured. Data analysis was done according to Tesch’s open coding data analysis method. The findings revealed four emerging themes: service provision factors that impact on reproductive health promotion provision; barrier factors towards safer sex practice; low health literacy of females regarding reproductive health promotion, and disclosure of positive HIV status. In phase 2, the conceptual framework was described according to the survey list of Dickoff, James and Wiedenbach (1968) and the Research Model in Nursing as described in the Theory for Health Promotion in Nursing (University of Johannesburg, 2009). In phase 3, the described conceptual framework served as the guideline for the model development guided by Chinn and Kramer’s (2008) theory and model generating design. Two phases of model evaluation was done: firstly by clinical experts and secondly by academic experts. The model that was developed was based on collaboration, community participation, and cooperative decision making processes and was named: A model to collaborate the provision of reproductive health promotion services in PHC settings. The outcomes from implementing this model envisaged to be the reduction of unintended pregnancy, STIs, and HIV and AIDS among females and males.

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.

Introduction: Unintended pregnancies are associated with poor health and economic outcomes. The use of modern contraceptive methods has been proven to be effective in reducing unintended pregnancy. Historical barriers in access to care experienced by rural communities suggest that rural women may also experience barriers in accessing reproductive health services. However, little is known about geographic variation in reproductive health services. The primary aim of this study is to examine rural and urban differences in access to and utilization of contraceptive methods among publicly funded clinics in South Carolina. Methods: A cross-sectional study of all Federally Qualified Health Center (FQHC) and Department of Health & Environmental Control (DHEC) family planning clinics in South Carolina offering reproductive health services in 2017 was used to examine access to and utilization of contraceptive methods. Administrators or organizational representatives with knowledge of clinic operations were asked to complete a survey specific to the provision of contraceptive services. Two outcomes from the survey were of primary interest. Access to a full range of contraceptive methods was operationalized as a dichotomous variable reflecting whether or not an individual method was directly available on-site. Utilization was defined as the percent of women using individual methods, relative to the overall distribution of women receiving contraceptive services. The Rural-Urban Continuum Codes (RUCC) were used to categorize clinic as rural or urban. RUCC codes 1, 2 and 3 were classified as urban, while codes 4 through 8 were classified as rural. Contraceptive methods were examined individually and aggregated into 3 groups: highly effective reversible methods, moderately effective methods and least effective methods. Bivariate relationships between the two-level RUCC variable and provision of contraceptive methods were examined using a Chi-square test for independence. An independent t-test was also used to examine differences in contraceptive utilization based on rural or urban clinic designation. Results: The study population consisted of 105 clinics, with 60% of clinics in urban areas and 40% in rural areas. Across the state of South Carolina, 75% of clinics offer highly effective contraceptive methods without having to schedule a follow-up visit to receive the method. Although not statistically significant, among clinics that offered highly effective reversible contraceptives on site, 79% of such methods are available in urban communities compared to 74% in rural and communities (p=0.49). About 12% of women at urban clinics utilized highly effective reversible methods compared to 7% of women at rural clinics (p=0.02). This appears to be driven by less access to and utilization of hormonal implants (9% among urban clinics compared to 5% among rural). Conclusion: Access to highly effective methods through publicly funded providers is similar in rural and urban communities; however, rural/urban differences in the utilization of highly effective methods, specifically implants, was noted. Given historical disparities in access and transportation barriers among rural population, decreased access and utilization of methods that allow for longer durations between provider visits could be problematic. These findings suggest that increased efforts ensuring access to long acting reversible contraception in rural clinics is warranted.

Introduction: Contraceptive decision-making is individual in nature and access to high-quality contraceptive care, including counseling and the full range of contraceptive methods, can help individuals achieve their personal reproductive goals and prevent unintended pregnancy. The COVID-19 pandemic disrupted provision and utilization of contraceptive counseling and contraceptive methods. Long-acting reversible contraception (LARC) methods, such as the contraceptive implant and intrauterine devices (IUDs), were particularly affected by the pandemic because they require placement by a health care provider in a clinical setting. Choose Well (CW), an ongoing statewide contraceptive access initiative in South Carolina, launched in 2017 and continues through 2022. CW aims to implement best practices of contraceptive care via training and funding for IUD and implant methods. This study examined the perceptions of access to contraceptive counseling and implant and IUD methods during the pandemic in 2020 among CW hospital partners. Methods: Data were collected in 2021 via key informant interviews with partners (n=9) at CW implementing hospitals to assess perceptions of CW activities in 2020, the first year of the COVID-19 pandemic. A semi-structured interview guide was used, and interviews were recorded, transcribed, and consensus coded. A codebook was developed based on the interview guide. Data from select questions of interest related to perceived access to contraceptive counseling, access to LARC methods, and the impact of the pandemic on contraceptive care services were analyzed for this study. Coding was conducted with NVivo software version 1.6.1. Results: Findings show that there was continued provision of contraceptive services during COVID-19 at CW partner hospitals, including an increase in access to contraceptive counseling and LARCs in 2020. The most prevalent facilitator for increased access to contraceptive counseling and LARCs at CW partner hospitals was having key personnel available such as physicians and Obstetrics (OB) navigators. Expanded access to outpatient sites was also noted as a facilitator of contraceptive counseling. Advertising and wide-spread patient education, buy-in and engagement from staff were additional facilitators for the increased access to LARCs. Considering the context of the COVID-19 pandemic, patients wanting to quickly leave the hospital and challenges with staffing contributed to an overall decline in access in some hospital locations. Challenges with staffing included not being able to receive training and nurses being overworked and overburdened. Conclusion: While COVID-19 has posed challenges to contraceptive care service provision, most individuals perceived an increase in access to contraceptive counseling and LARCs at CW partner hospitals. Hospital partners have continued to provide contraceptive services during COVID-19. The findings suggest the success of the CW initiative in increasing access to contraceptive services, particularly during COVID-19 through key facilitators. Staffing positions such as OB Navigators should be funded and maintained to increase access to contraceptive care services in hospital inpatient settings. Coordinating care between hospital inpatient and outpatient settings is similarly important for widespread patient education about contraceptive care services.

INTRODUCTION: Half of all pregnancies in South Carolina are unintended (mistimed or unwanted) and are associated with a higher risk for adverse maternal and infant health outcomes. South Carolina has a wide network of publicly supported clinics providing reproductive health services, including the Department of Health and Environmental Control, Federally Qualified Health Centers, and Rural Health Clinics. Having a better understanding of the geographic distribution of women in need of publicly funded contraceptive services is crucial for health planning and improving health delivery systems. METHODS: The total number of reproductive-aged women (15-44 years) in South Carolina was drawn from the 2017 American Community Survey (ACS) 5-Year Estimate files housed by the U.S. Census Bureau. A four-step process was used to estimate the number of reproductive-aged women in need of publicly funded contraceptive services at the county-level. First, the number of women between 15-19 years of age in each county was established. Next, the number of women with family incomes <100% of the federal poverty level in each county was identified. Data from the South Carolina Statewide Survey of Women, conducted by NORC at the University of Chicago, were used to estimate the number of reproductive-aged women (18-44) at-risk for experiencing an unintended pregnancy. The proportion of the women who were not sterile, not currently pregnant or not trying to get pregnant in the next 3 months was considered at-risk (76.24% of the total sample). The proportion of women at-risk was used to adjust the estimates of the total number of low-income women between 20-44 years of age in need of publicly funded contraceptive services in each county. The adjusted number of low-income women and the number of women less than 20 years of age were combined to estimate number of women in need of publicly funded contraceptive services. FINDINGS: There are an estimated 950,978 women of reproductive age living in South Carolina; of these women, about 40% (N=374,000) are considered in need of publicly funded contraceptive services. County-level need estimates ranged from 33.5% to 57.8% (M = 42.2%, SD = 4.8%) of the total reproductive-aged female population. While the number of women in need followed a typical population density pattern, rural communities had higher proportions of women in need of publicly funded contraceptive services, relative to the total population of reproductive-aged women. Rural counties comprised 91% of counties with the greatest need for publicly funded contraceptive services. CONCLUSIONS: Proportionally, the need for publicly funded contraceptive services is greater in rural and low-resource counties. While ensuring services are available among large population centers is certainly warranted, these findings also suggest that access to contraceptive services in rural counties is also needed and should be considered in health planning and service allocation policies and practices.

Adolescent reproductive health services (ARHS) in Gauteng Province are not meeting the reproductive health needs of adolescents. There is also no formalised adolescent/youth policy laid down to assess the quality of care given to adolescents attending these clinics although the policy is currently in the process of being finalised. The purpose of the study therefore was to critically analyse the ARHS in Gauteng Province to determine which adolescents attended the clinics, whether the clinics were accessible and available and whether they provided comprehensive care, gave information and counselling to the adolescent and whether the clinics \\·ere adolescent-friendly. Using the quality care model as the conceptual framework for the study, the following research questions were asked to determine the quality of care in terms of the adolescent's needs at these clinics: Who is the adolescent using ARHS in Gauteng Province') Are the ARHS in Gauteng Province accessible and available to adolescents? Do the ARHS in Gauteng Province provide comprehensive care to adolescents? Are adolescents receiving information and counselling from the ARHS in Gauteng Province? Are the ARHS in Gauteng Province adolescent-friendly? A quantitative cross-sectional exploratory, descriptive research design using a self-administered, researcher­ designed questionnaire was used to collect data from a 203 nonprobability convenient sample, at selected ARHS in Gauteng Province. The analysed data indicated that females in the older age group. ie 18-19 years used the ARHS more than the female adolescents in the younger age group and males. Findings also indicated that the ARHS in Gauteng Province are geographically accessible and available to adolescents. However, there appeared to be a need to extend the days and hours of functioning of the ARHS so as to make them more accessible and available to adolescents. Comprehensive care is not given to adolescents attending ARHS. Adolescent gave contradictory mformation especially with regard to the attitudes of service providers. Recommendations made include management strategies that will attract the adolescent in the younger age group and in particular the male adolescent. This necessitated that service providers at ARHS be equipped with the appropriate information given in an outcome-based format in adolescent care. / Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

Adolescent reproductive health services (ARHS) in Gauteng Province are not meeting the reproductive health needs of adolescents. There is also no formalised adolescent/youth policy laid down to assess the quality of care given to adolescents attending these clinics although the policy is currently in the process of being finalised. The purpose of the study therefore was to critically analyse the ARHS in Gauteng Province to determine which adolescents attended the clinics, whether the clinics were accessible and available and whether they provided comprehensive care, gave information and counselling to the adolescent and whether the clinics \\·ere adolescent-friendly. Using the quality care model as the conceptual framework for the study, the following research questions were asked to determine the quality of care in terms of the adolescent's needs at these clinics: Who is the adolescent using ARHS in Gauteng Province') Are the ARHS in Gauteng Province accessible and available to adolescents? Do the ARHS in Gauteng Province provide comprehensive care to adolescents? Are adolescents receiving information and counselling from the ARHS in Gauteng Province? Are the ARHS in Gauteng Province adolescent-friendly? A quantitative cross-sectional exploratory, descriptive research design using a self-administered, researcher­ designed questionnaire was used to collect data from a 203 nonprobability convenient sample, at selected ARHS in Gauteng Province. The analysed data indicated that females in the older age group. ie 18-19 years used the ARHS more than the female adolescents in the younger age group and males. Findings also indicated that the ARHS in Gauteng Province are geographically accessible and available to adolescents. However, there appeared to be a need to extend the days and hours of functioning of the ARHS so as to make them more accessible and available to adolescents. Comprehensive care is not given to adolescents attending ARHS. Adolescent gave contradictory mformation especially with regard to the attitudes of service providers. Recommendations made include management strategies that will attract the adolescent in the younger age group and in particular the male adolescent. This necessitated that service providers at ARHS be equipped with the appropriate information given in an outcome-based format in adolescent care. / Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

Magister Public Health - MPH / The aim of this study was to describe the health seeking behaviours, knowledge about the available services, as well as experiences, and barriers to access and utilization of the reproductive health services among male adolescents in Lusaka. A descriptive, qualitative study was conducted among male adolescents in a peri-urban setting in Lusaka. Four focus group discussions were conducted with 46 adolescents aged between 13 and 24 years of age, and six key informant interviews. Data was audio-tape recorded and transcribed verbatim. Thematic content analysis was done. Health concerns were related to the social, psychological, societal and puberty needs of participants. Concerns, questions and queries about masturbation were common, especially among the younger adolescents. Most problems related to puberty and body changes rather than sexual and reproductive health matters per se. Knowledge about the available sexual and reproductive health services was generally low, with some young men being completely unaware of the existence of youth friendly services at the local clinic. Contrary to popular opinion, adolescents in this community reported that they did not seek help on sexual matters from friends and did not want to discuss their problems with their peers, due to fears of being marginalized. Perceived gender, cultural and social norms, lack of knowledge about the availability of adolescent reproductive health services, and poor attitudes among the health care providers were some of the identified barriers to seeking health care. Adolescents perceived health providers to be judgmental, not helpful and condescending towards young people. Lack of privacy and confidentiality were also reported as barriers to access and utilization of sexual and reproductive health services

Introduction: The consequences of the opioid epidemic and various prevention, mitigation, and treatment strategies have a strong hold on Appalachian communities. However, limited research has been conducted to understand the experiences of special populations impacted by opioids in this region, such as women of childbearing age living with opioid use disorder (OUD) prior to and during pregnancy. The objective of this review is to summarize existing literature on the care experience for women of childbearing age receiving treatment with medications for opioid use disorder (MOUD) in rural east Tennessee. This literature review will allow for better understanding of current treatment practices, potential gaps in care, and needed care system improvements for this patient population. Methods: A systematic PubMed search identified studies focused on MOUD and pregnancy in the rural eastern Tennessee region. Search results were screened to remove publications older than five years or from outside the region. Relevant information concerning the MOUD care experience for women of childbearing age in the area was collected from these studies. Results: Five studies were included: four surveys and a systematic review. All were published within the last five years and described experiences spanning preconception to postnatal care as well as Tennessee opioid laws that affect women of childbearing age. Two studies detailed the pre-pregnancy care experience, including information about prior pregnancies, intention of conception, contraceptive use, and perceived barriers to contraception access among women receiving MOUD. Two studies described the care experience during pregnancy and its evolution in recent years with changes in acceptance of insurance for MOUD treatment, rates of MOUD-positive prenatal drug screens, and MOUD tapering practices during pregnancy. The final included study reviewed several Tennessee opioid laws enacted over the years to combat prenatal substance use and neonatal abstinence syndrome (NAS). Notably, while total reported cases of NAS have decreased statewide in recent years, the highest rates continue to be observed in east Tennessee, with a majority of cases linked to MOUD exposure. The requirements and enforcement of NAS-related legislation in Tennessee have changed over time but their existence may deter pregnant women from seeking treatment due to fear of punitive consequences. Conclusion: The evidence compiled in this literature review points to many areas in which the care experience can be improved for women of childbearing age receiving MOUD in east Tennessee. There are concerns regarding pregnancy planning, contraceptive access, availability of evidence-based OUD treatment, cost of treatment, and fear of actual or potential negative repercussions from opioid use during pregnancy. These findings suggest multiple efforts can be undertaken by clinicians, researchers, and policymakers to enhance the experience of care for women of childbearing age living with OUD, and consequently improve the health of the population in general, in this region of Appalachia.