BACKGROUND: Obstetric fistula (OF) is described as a health and human rights tragedy due to its devastating consequences and debilitating sequelae. In sub-Saharan Africa, the lifetime prevalence of OF symptoms is estimated at 3.0 cases (95% CI 1.3-5.5) per 1000 women of reproductive age. In Guinea, this prevalence is 6·0 (95% CI 3·9–7·4) per 1000 women of reproductive age, a double that of sub-Saharan Africa. As maternal mortality reduction is accelerating in many countries due to better access to cesarean section and more women are benefiting treatment for OF worldwide, women who have a successful fistula repair need more attention to prevent fistula recurrence and adverse maternal and neonatal outcomes.AIM: To analyze the long-term reproductive health outcomes in women who undergo fistula surgery in Guinea and contribute to closing the knowledge gap on the reproductive health of women after fistula surgery.METHODS: The situational analysis of fistula management programs in Guinea included three retrospective cohort studies. Study I analyzed the clinical outcomes of fistula care programs in Guinea. Study II analyzed the trends and factors associated with loss to follow-up after surgical repair of obstetric fistula in Guinea. Study III estimated the overall proportions of surgical failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identified factors associated with these outcomes. To analyze the health and reproductive outcomes in women after female genital fistula surgery in Guinea, two studies (IV and V) were conducted. Study IV critically reviewed the existing literature on pregnancy and childbirth post repair of obstetric fistula and Study V analyzed the incidence of fistula recurrence and pregnancy post repair along with the associated maternal and neonatal outcomes. RESULTS: Routine programmatic repair of OF was found to achieve satisfactory short-term clinical outcomes with 85% of women having their fistula closed and 79% becoming continent after surgery (Study I). However, additional 18% recurrence and 10% residual urinary incontinence were recorded within 28 months median follow-up post-surgery (Study V). Reimbursement of transportation costs and the reduction of geographical barriers to care for women with OF were highly related to reduced loss to follow-up after hospital discharge (Study II). Women who present for surgery with a damaged urethra and those who delivered vaginally during the delivery leading to the fistula were more likely to experience surgical repair failure and residual urinary incontinence (Study III). Women who become pregnant and deliver after fistula repair in sub-Saharan Africa were identified as carrying high risk of adverse maternal and neonatal health outcomes (Study IV). In Guinea, only few women achieved pregnancy (28%) after surgery. Stillbirths (24%) and recurrence of fistula after delivery (14%) were common among women who delivered after fistula repair (Study V). CONCLUSIONS: Improving the performance of fistula management programs in the context of decentralization of services in Guinea needs therefore to integrate long-term perspectives. This should include establishing a “level of care framework” into fistula surgery along with training for health providers, tracing of women after repair, and increased community awareness-raising that include men and target gender inequalities (Studies I to III). Increasing funding and support for fistula care from both local governments and international donors is needed in the current context of decentralization of fistula care to address service gaps for women suffering from fistula (Studies III to V). Achieving a fistula free generation should include interventions to address women’s vulnerability before fistula formation and after fistula repair (Studies IV and V). / Doctorat en Sciences de la santé Publique / info:eu-repo/semantics/nonPublished

More than 50 million people were forcibly displaced from their homes at the end of 2014, the highest number since World War II; 38 million of these were displaced within their own country rather than crossing an international border. Many have been displaced multiple times by chronic and recurring conflict. Complex humanitarian emergencies caused by armed conflict are characterized by social disruption, population displacement and the breakdown of national health systems. The negative impact of war and displacement on women has long been recognized, including by compromising their right to sexual and reproductive health (SRH) services. The ten countries with the highest maternal mortality ratios in the world are affected by, or emerging from, war; these countries are also characterized by low contraceptive prevalence. The provision of SRH services is a minimum standard of health care in humanitarian settings; however access to these services is still often compromised in war. A 2012-2014 global evaluation on the status of SRH in humanitarian settings showed that although access to SRH services has improved in humanitarian settings, gaps persist and the availability of contraceptive services and information is still weak relative to other SRH components. This dissertation addresses this gap by providing evidence that good quality contraceptive services can be implemented in humanitarian settings and that women and couples will choose to start and continue contraceptive use. The first paper of this dissertation, a systematic review, explored the evidence regarding SRH services provided in humanitarian settings and determined if programs were being evaluated. In addition, the review explored which SRH services received more attention based on program evaluations and descriptive data. Peer-reviewed papers published between 2004 and 2013 were identified via the Ovid MEDLINE database, followed by a PubMed search. Papers on quantitative evaluations of SRH programs, including experimental and non-experimental designs that reported outcome data, implemented in conflict and natural disaster settings, were included. Of 5,669 papers identified in the initial search, 36 papers describing 30 programs met inclusion criteria. Some SRH technical areas were better represented than others: seven papers reported on maternal and newborn health (including two that also covered contraceptive services), six on contraceptive services, three on sexual violence, 20 on HIV and other sexually transmitted infections and two on general SRH topics. In comparison to the program evaluation papers identified, three times as many papers were found that reported SRH descriptive or prevalence data in humanitarian settings. While data demonstrating the magnitude of the problem are crucial and were previously lacking, the need for SRH services and for evaluations to measure their effectiveness is clear. Contraceptive services were mostly limited to short-acting methods and received less attention overall than other SRH technical components. In response to this lack of evidence for the implementation of contraceptive services in humanitarian settings, two contraceptive services programs implemented by CARE and Save the Children among conflict-affected populations in eastern Democratic Republic of the Congo (DRC) were evaluated. DRC has experienced chronic conflict for two decades, ranging from acute to post conflict phases. People have been displaced internally for many years while others have experienced repeated cycles of displacement and return. First, cross-sectional surveys in 2008 (n=607) and 2010 (n=575) of women of reproductive age using a multi-stage cluster sampling design and facility assessments were conducted in Maniema province. Data on the numbers of clients who started a contraceptive method were also collected monthly from supported facilities. Current use of any modern contraceptive method doubled from 3.1% to 5.9% (adjusted OR 2.03 [95%CI 1.3-3.2]). Current use of long-acting and permanent methods (LAPM) increased from 0 to 1.7%, an increase that was no longer significant after adjustment. Program changes were made to improve service quality in 2010; provider skills and counseling improved and commodities became consistently available. Service statistics indicate that the percentage of clients who accepted a LAPM at supported facilities increased from 8% in 2008 to 83% in 2014. This study demonstrates that when good quality contraceptive services, including LAPM, are provided among conflict-affected populations, women will choose to use them. Second, a retrospective cohort study measured 12-month contraceptive continuation in North Kivu province. A total of 548 women (304 short-acting and 244 long-acting method acceptors) were interviewed about their contraceptive use in the previous year. At 12 months, 81.6% women reported using their baseline method continuously, with more long-acting than short-acting method acceptors (86.1% versus 78.0%, p=.02) continuing method use. Use of a short-acting method (HR 1.74 [95%CI 1.13-2.67]) and desiring a child within two years (HR 2.32 [95%CI 1.33-4.02]) were associated with discontinuation at 12 months. Given the association between service quality and contraceptive continuation, the program’s focus on service quality including improvements to provider skills and activities to address provider attitudes likely contributed to these results. The impressive continuation rates found here indicate that delivering high quality contraceptives services in these settings is possible, even in a difficult and unstable setting like eastern DRC. This dissertation represents a major contribution to the field of SRH in humanitarian settings, and has implications for research and programs. First, these results strengthen the evidence base for the implementation of contraceptive services in humanitarian settings, and demonstrate to implementers and donors of humanitarian aid that effective programs resulting in adoption and continuation of contraceptive methods can be successfully implemented in these challenging settings. Second, these programs were implemented in full collaboration with the Ministry of Health (MOH), supporting MOH facilities and health workers, thus strengthening the health system. Third, the programs achieved these impressive results in rural DRC where they attracted early adopters, most of them first time contraceptive acceptors. In addition, these programs were implemented by multi-sectoral, as opposed to SRH-specific, non-governmental organizations that made good quality contraceptive services a priority, further reinforcing the inclusion of contraceptive services as a routine component of humanitarian health response. Finally, both programs evaluated in this dissertation focused strongly on improving the quality of contraceptive services with specific attention to training, supervision, provider attitudes, data use and commodities management. This program focus on quality contributed to the positive findings. Making good quality contraceptive services available is challenging and requires sustained commitment, funding and program adjustments, but, in the programs studied here, was ultimately successful. Given true choice, when a range of methods was routinely available, women, many of whom had no prior experience with contraceptive use, were able to choose the method that best served their needs and continued to use their preferred method. These results add to the limited evidence on contraception in humanitarian settings, and demonstrate that even in remote and unstable settings, when good quality contraceptive services, with a choice of short-acting, long-acting and permanent methods, are in place, women will not only choose to start, but also continue, to use contraception to exercise their right to reproductive choice.

A tese analisa a educação e saúde reprodutiva de adolescentes femininas de periferia urbana, pesquisando os reflexos da educação formal nos seus conhecimentos sobre saúde. Trata-se de um estudo exploratório descritivo, estruturado a partir de uma abordagem qualitativa. Os campos de desenvolvimento do Estudo de Caso foram uma Unidade Básica de Saúde e uma escola pública municipal, na região metropolitana de Porto Alegre, RS, Brasil. Foram participantes da pesquisa 17 adolescentes freqüentadoras da Unidade Básica de Saúde, sendo adotados como procedimentos metodológicos a pesquisa bibliográfica e documental e entrevistas semi-estruturadas. Há contradições e conflitos entre os conhecimentos trazidos pelo desenvolvimento científico na busca por uma situação ideal de saúde e a realidade da população que freqüenta as escolas da periferia urbana. O estudo se propõe a contribuir na formação dos professores ao trazer a voz dos que são sujeitos da atividade educacional, analisando o que os adolescentes entendem, esperam, criticam e admiram durante a vivência na escola, o que levam para seu cotidiano e seus sonhos de futuro, como ocorrem as ligações e relações entre os alunos, suas famílias e as propostas das escolas, da sociedade, das políticas públicas. A tese sugere que a educação em saúde reprodutiva na escola não respondeu às necessidades das adolescentes e o abandono da escola está relacionado às suas difíceis condições de vida e perspectiva de futuro. A integração entre a Unidade Básica de Saúde e a escola possibilita a produção de saúde e educação, objetivo de todos os profissionais que vivem e trabalham na perspectiva das transformações sociais. / The present thesis analyses female teenagers` education and reproductive health in urban periphery, researching the impact of formal education on their knowledge about health. It is an exploratory-descriptive study, structured on a qualitative approach. The fields of the Case Study were a Basic Health Unity and a public school in the metropolitan region of Porto Alegre, RS, Brazil. 17 teenagers, who attended that Basic Health Unity, were participants at the research. The used methodological procedures were documentary and literature review, in addition to semi-structured interviews. Considering the contradictions and conflicts among scientific knowledge (which is developed on ideal conditions of health) and the reality of people that attends the schools in the urban periphery, this study aims to contribute in teachers` formation, bearing in mind what students take from school to daily life; their perceptions, expectations and critics related to school time; and finally, how the connections between students, families and school happen. The results reached by this study suggest that reproductive health education in school doesn’t correspond to teenagers` needs and that school abandon by teenagers is related to their hard conditions of life and low expectations concerning their future. The integration between Basic Health Unity and school makes possible the production of health and education – what should be the main objective of all professionals that live and work in the perspective of social transformations.

Rwanda experienced genocide from April to July 1994 during which over 800,000 people were murdered. Among the far-reaching changes that followed this event among individuals and in society overall, the Rwandan Demographic and Health Surveys (DHS) showed that contraceptive prevalence declined from 13% in 1992 to 4% in 2000 among married women of reproductive age. This dissertation has two hypotheses concerning Rwandan women's fertility preferences and behavior following the genocide. It is hypothesized that, first, high levels of conflict reduced women's desire for a child or for additional children and second, that women who experienced relatively high levels of conflict were more likely to act on their wish to not have a child or another child by using modern contraceptives than were women who experienced relatively low levels of conflict. The study's logistic regression dependent (outcome) variables were desire for a or another child and the use of modern contraceptives; the source for these data was the 2000 DHS. Three groups of independent variables were included: socio-demographic variables, also from the 2000 DHS, included age, number of living children, education level, urban/rural residence and socio-economic status; availability of family planning services, assessed using women's perception of distance as a barrier to obtaining health care for themselves, from the 2000 DHS, and quality of health services, assessed with data from the 2001 Service Provision Assessment; and experience of conflict, measured as the percentage of the 1994 commune populations that resided in refugee camps in 1995. Communes were considered `high migration' if 10 percent or more of their populations migrated to camps and `low migration' if less than 10 percent of their populations migrated to camps. Women who lived in high migration communes were considered to have relatively high experience of conflict and those who lived in low migration communes were consider dot have relatively low experience of conflict. Analysis showed that residents of high migration communes were significantly less likely to want a or another child as compared to residents of low migration communes (OR = .74); it appeared that the social environment of high migration had a dampening effect on desire for children. The analysis also showed that residents of high migration communes were significantly less likely to use a modern contraceptive method than were those of low migration communes (OR = .57), even though they were less likely to want a or another child and even when family planning services were reasonably available. The reasons for these results are unclear, and many factors may contribute. The generalized trauma experienced by the population may have had a numbing effect, in which taking action in any domain was difficult. Women may have felt pressured by society to have children as the society emerged from war, despite their own preferences. The population may also have distrusted government health facilities - the only source of services for most - in light of the interactions with officials during and after the genocide. However, another set of reasons specific to women and women's health may also have influenced the findings. There is a pervasive social stigma around reproductive health; these services have generally lagged behind other primary health care components. Moreover, rape was used as a weapon of war in the genocide; these experiences may have reduced women's willingness to seek reproductive health services specifically. Finally, the Rwandan genocide and its preparation were decidedly misogynistic; this pervasive dehumanization may have made it particularly difficult for women to seek care for their sexual and reproductive health needs and desires. This complex personal, social, physical and political context may explain why Rwandan women who may not have wanted a child or additional children nonetheless did not consistently act on their desires in the years following the 1994 genocide. The dissertation includes a series of essays providing the author's personal perspective on working in Rwanda in the 1980s and 1990s and being present in the country at the start of the genocide in April 1994.

This dissertation aims to contextualize the normative and structural constraints on women's bodies, health, and wellbeing in rural Tamil Nadu, India. Using theoretical frameworks by R.W. Connell and Michel Foucault, this qualitative study explores the intersection of gender and power at interpersonal-, institutional-, and community-levels. Findings from this research highlight specific manifestations of the local gender regime that women may need to overcome to better care for their bodies and selves.

Objetivo: descrever as características dos homens submetidos à vasectomia na rede pública do Município de Campinas, SP, e investigar a sua percepção quanto às conseqüências da esterilização em algumas áreas de sua vida e as relações entre as circunstâncias da cirurgia e essas conseqüências. Procedimentos metodológicos: estudo descritivo, com um componente qualitativo e outro quantitativo. Após a identificação dos sujeitos, eles foram contatados via telefone ou correio. Para a etapa qualitativa, se realizaram 10 entrevistas semi-estruturadas com homens selecionados de acordo com critérios propositais de escolaridade e número de filhos. Em seguida, foi aplicado um formulário estruturado a 202 homens, sorteados a partir da lista completa daqueles que haviam sido vasectomizados entre 1998 e 2004. As entrevistas semi-estruturadas foram transcritas e inseridas no programa The Ethnograph para desvelar as unidades de significado ou temas identificados. Os dados obtidos através dos formulários estruturados foram digitados através do módulo data entry do programa computacional SPSS. A análise dos dados quantitativos foi, inicialmente , descritiva, preparando-se tabelas com a distribuição de freqüências das principais variáveis estudas, de acordo com os objetivos definidos. Em seguida, foi avaliada a associação entre possíveis conseqüências da vasectomia e caracterísitcas dos homens e circunstâncias de vida em que a cirurgia foi realizada utilizando-se o teste qui-quadrado. Resultados: os resultados evidenciaram algumas mudanças no perfil dos homens que se submeteram à vasectomia com crescimento na porcentagem dos que tinham renda per capita até R$ 300,00: 47,6 por cento no período entre 1998-1999 e 61,3 por cento entre 2003 e 2004. Esse crescimento foi mais significativo entre os homens com menos de 35 anos de idade e que tinham dois ou mais filhos vivos na ocasião da cirurgia. A análise dos dados qualitativos revelou que os homens, em geral, consideravam que a decisão de submeter-se à vasectomia havia sido deles próprios e não admitiam influência de outras pessoas. Porém, ficou evidente que a decisão de operar-se só foi tomada diante do exemplo de pessoas significativas outros homens que testemunhavam da inocuidade do procedimento sobre a vida sexual. Essa decisão também, em geral, só foi tomada quando a esposa/companheira não podia mais usar outro método contraceptivo. Observou-se que 97 por cento estavam satisfeitos por terem feito a cirurgia e pouca referência a efeitos indesejados em distintas áreas de sua vida. Pouco mais da metade dos entrevistados atribuiu à vasectomia mudanças para melhor sobre sua saúde, corpo, relacionamento em geral com a família e situação econômica. Quase dois terços referiram-se a esse tipo de mudanças na vida sexual e no relacionamento em geral com a esposa. Prevaleceu a idéia de que a vasectomia só trouxera benefícios, principalmente maior tranqüilidade nas relações sexuais, sem medo de engravidar. Nas entrevistas semi-dirigidas a possibilidade de arrependimento foi mencionada como um potencial aspecto negativo da vasectomia, para a qual não havia solução na opinião dos entrevistados. Entre os poucos homens insatisfeitos com a vasectomia, apenas um havia feito a reversão da cirurgia porque vivia com uma nova companheira e queria ter filhos; entre os demais a insatisfação devia-se à dor provocada pelo procedimento cirúrgico. Conclusões: no contexto da regulamentação legal, o acesso à vasectomia parece facilitado aos homens com menor renda, mais jovens e com maior número de filhos, que optam pela cirurgia quando não vêem outra opção para regular a fecundidade do casal. Os homens tendem a intervir, na medida em que se percebem incapazes de cumprir seu papel de provedor da família. A possibilidade de fazer a vasectomia fica condicionada pelo acesso ao método e pelas informações sobre o mesmo, especialmente aquelas providas por pessoas significativas. O crescimento na busca pela vasectomia deve ser visto também de forma crítica: não apenas porque, necessariamente, não indica maior eqüidade nas relações de gênero, mas também porque segue testemunhando as deficiências de acesso ao planejamento familiar em nosso meio / Objective: to describe the characteristics of men who underwent vasectomy at the public service in Campinas, state of São Paulo and investigate their perception regarding the consequences of sterilization in some areas of their life, as well as the possible relationship between the circumstances of the surgery and these consequences. Methodology: A descriptive study including a qualitative and a quantitative component was carried out. Participants were contacted by telephone or by mail. For the qualitative phase semi-structured interviews were conducted with 10 men, selected according to purposeful sampling criteria concerning schooling and number of children; after that a pre-tested structured form was completed by 202 men, randomly chosen by lot from the complete list of those who had been vasectomized between 1998 and 2004. The semi-structured interviews were verbatim transcribed and the The Ethnograph program was used in the thematic analysis of content, for the identification thematic units or themes in the discourse of the participants. The data obtained through the structured forms were typed using the data entry module of the SPSS computer program. For the descriptive analysis tables were prepared with the frequency of the variables studied. Subsequently, the association among possible consequences of vasectomy, participants characteristics and the life circumstances in which the surgery performed were evaluated through the Chi-square test. Results: Some changes in the characteristics of man who underwent vasectomy were observed: an increase in the percentage of men sterilized who had per capita up to R$ 300,00 (three hunfred reais): that is, 47.6 per cent in the period of 1998-1999 and 61.3 per cent between 2003 and 2004. This increase was significant among the men who were less than 35 years old and had two or more live children at the moment of surgery. Analysis of the interviews showed. that men considered that the decision to undergo vasectomy was their own and did not report a great influence of other people. However, it became evident that the decision to perform the surgery was only made in face of the example of significant people other men who witnessed that the procedure was innocuous and had no adverse effect on their sexual life. This decision was usually only made when the wife/partner could no longer use another contraceptive method. Satisfaction with surgery (97 per cent ) and only a few reports of unwanted effects in different areas of their lives were observed. A little more than half of the interviewed participants mentioned positive changes on their health, body, relationship with the family and economic situation. About two thirds reported that these changes in their sexual lives and in the relationship with the wives.. The prevalent idea was that vasectomy brought benefits, mainly more tranquility in their sexual relationship without fear of pregnancy. In the semistructured interview the possibility to regret was mentioned as a potencial negative aspect of the vasectomy. It was mentioned for the participants as a problem without a solution. Among this few men not satisfied with the vasectomy, only one had done the reversion of the surgery because he had a new partner and they wanted more children, among the other the pain caused by the surgery procedures made them feel dissatisfaction. Conclusion: Considering the legal regulation context, the access to vasectomy seems to be facilitated for the men with low income, young and high number of children, who choose the vasectomy when they did not have another option to regulate the couple fertility. The men will act when they realize if the fertility was not interrupted they will unable to keep their role of family provider. The possibility to do vasectomy is conditioned by the access to the method and by the information about it, especially those provided by significative people. The increase in the number of men who choose vasectomy should be viewed critically not only because it does not indicate balance in the gender relation but also because the access to family planning presents some deficiencies in our environment

Philosophiae Doctor - PhD / The prevention of abortion related complications and mortality is dependent on the availability, accessibility and usability of emergency post-abortion care (PAC) throughout the health care system. Unfortunately, abortion is not legal in Nigeria and Nigerian women, especially adolescents, are often unable to obtain adequate post-abortion care services due to a variety of reasons. A review of literature shows that adolescent PAC patients receive worse care than older women seeking PAC services. There is widespread recognition of the need to overcome these barriers and make it easier for women to obtain the PAC services they need. Therefore, overall aim of this research study was to provide empirical information on the barriers and challenges to adolescents' PAC and develop a policy document to inform reproductive health services for Nigerian hospitals. To develop this policy document, the study specifically sought to assess knowledge of reproductive-health and related post-abortion care services among health care providers; describe the adolescents' perception of post-abortion care received; determine the service providers' perspectives on adolescents' post-abortion care challenges and barriers; analyze the challenges and barriers faced by adolescents in obtaining post-abortion care services; explore ways in which the knowledge about challenges and barriers to adolescents' post-abortion care can be used to inform policy; develop policy document and make recommendations in key areas to improved PAC services in Nigeria as part of working towards improving reproductive health services.

Ao se realizar uma interface entre a violência por parceiro íntimo (VPI) e suas relações para com a saúde da mulher, nota-se que as situações de violência tanto física como a sexual e psicológica afetam claramente a saúde sexual e reprodutiva, com impactos importantes. O presente estudo tem por objetivos: analisar aspectos da saúde reprodutiva das gestantes que estão associados à situação de VPI, durante a presente gestação; e identificar a prevalência de casos de VPI e classificar quanto ao tipo e momento da ocorrência. Trata-se de um estudo descritivo, do tipo transversal, desenvolvido com gestantes em acompanhamento de pré-natal no CRSM-MATER, uma maternidade de baixo risco na cidade de Ribeirão Preto-SP. A coleta de dados foi realizada através da aplicação de dois instrumentos, um para investigação da ocorrência da violência e outro para identificação de dados sociodemográficos e de saúde reprodutiva. Para verificar a associação entre as variáveis qualitativas, os dados foram submetidos ao Teste Exato de Fisher. Além disso, a quantificação desta associação foi mensurada por meio de modelos de regressão logística onde se calculou o Odds Ratio bruto (ORb) com seus respectivos intervalos de confiança de 95%. Todas as análises estatísticas foram realizadas com a utilização do software estatístico SAS® 9.0. A amostra constitui-se por 233 gestantes que passaram por consulta de pré-natal, no período de maio a dezembro de 2012. A ocorrência de VPI alguma vez na vida foi relatada por 55,36% das mulheres, enquanto, no período gestacional, verificou-se uma prevalência de 15,45% de violência geral, sendo 5,15% de violência física, 14,59% de violência psicológica e 0,43% de violência sexual. Observou-se associação entre a VPI e as mulheres que se autorreferiram de cor preta ou parda (p= 0,0052; ORb=3,344; IC 95%: 1,399; 7,997) e que não estavam em um relacionamento com seus companheiros, no período da entrevista (p= 0,0348; ORb =3,840; IC 95%:1,376; 10, 717). Nota-se uma tendência à VPI entre as mulheres em idade mais jovem, com baixa escolaridade e que não exercem atividade remunerada. As características de saúde reprodutiva apontam associação entre a VPI e as mulheres que não desejaram a atual gestação (p= 0,0020; ORb = 4,351; IC 95%: 1,786; 10,602), que raramente frequentam a consulta ginecológica (p= 0,0129; ORb = 2,971; IC 95%: 1,116; 7,911) e que, ao longo da vida, fizeram uso de método contraceptivo do tipo comportamental (p = 0,0572; ORb = 2,372; IC 95%: 1,023; 5,496). O estudo é precursor no Brasil e revelou algumas relações da VPI e suas implicações na saúde reprodutiva. Assim, outros estudos se fazem necessários para se compreender mais amplamente esta relação, além de se direcionar o olhar para a identificação das mulheres em situação de violência, a fim de melhorar as condições de saúde das mesmas, em especial da saúde reprodutiva, repensando as ações interventivas, relacionando-as não somente aos serviços de saúde mas também a uma conjuntura intersetorial / On establishing an interface between intimate partner violence (IPV) and its connection with the woman\'s health, we see that situations of violence, whether physical, sexual or psychological, have a clear effect on sexual and reproductive health, with important types of impact. The present study has two main purposes: first, to analyse those aspects of the reproductive health of pregnant women that are linked to situations of IPV during the pregnancy; and secondly, identification of the prevalence of cases of IPV and classify them according to the type and the moment of the occurrence. This is a descriptive study of the transversal variety, applied to pregnant women who are having antenatal care at CRSM- MATER, a low-risk maternity unit in the city of Ribeirão Preto, State of São Paulo, Brazil. The collection of data was made by applying two different instruments, one for the investigation of the occurrence of violence and the other to identify the social and demographic data and also the data regarding reproductive health. To check the association between qualitative variables, the data were subjected to the Exact Fisher Test. In addition, the quantification of this association was measured using models of logistic regression with the calculation of the raw odds ratio (rOR) with their respective confidence intervals of 95%. All the statistical analyses were carried out with the use of the statistical software SAS® 9.0. The sample consisted of 233 pregnant women who had antenatal care between May and December 2012. The occurrence of IPV at least once in life was reported by 55.36% of the women considered, while during the pregnancy the general violence rate of 15.45%, with 5.15% of physical violence, 14.59% of psychological violence and 0.43% sexual violence. There was a connection between IPV and women who declared themselves as black or partially skin-melaninated (p=0.0052; rOR = 3.840; IC=05%: 1.399; 7.997) and those who were not in a relationship with their partners at the time of the interview (p=0.0348; rOR=3.840; IC 95%: 1.376; 10.717). We also see a greater trend towards the presence of IPV among women who are younger, with lower levels of schooling, and who were not in paid work. The characteristics of reproductive health show an association between IPV and women who did not want the current pregnancy (p=0.0020; rOR=4.351; IC 95%: 1.786; 10.602), who rarely attend appointments with the gynaecologist (p=0.0129; rOR=2.971; IC = 95%: 1.023; 5,496). The study is the first of its kind in Brazil and has shown some relations between IPV and its implications related to reproductive health; other studies are therefore necessary so we may understand this relationship from a wider perspective, and also so we may direct our studies to the identification of those women in a situation of violence, with a rethink of intervention actions, relating them not only to health services but also to an intersectorial underlying situation

India has one of the highest rates of cervical cancer morbidity and mortality globally. Despite this, there are no national or state-wide screening efforts for cervical cancer and its prevention in India. In an effort to understand the magnitude of cervical cancer in Bangalore, India, this research draws upon data collected in hospital contexts over a month-long period to explore the ways in which physician attitudes contribute to understandings of cervical cancer and its prevention in the growing urban context of Bangalore.

Because Latinos are the largest, fastest-growing ethnic minority group in the U.S., learning more about their sexual and reproductive experiences and decision-making processes is important. Importantly, although sexuality and abortion are stigmatized in many Latino cultures and conservative religious beliefs specifically oppose abortion, Latinas have the highest birth rates in the U.S. and an estimated one in four pregnancies to Latina women are terminated (Jones, Darroch, &Henshaw, 2002; Jones, Finer, &Singh, 2010). Consequently, nuanced exploration of contradictions in reproductive behaviors and cultural and religious values is critical to supporting women's health and well-being. Seeking to advance the scholarship on the lived experiences of women who undergo elective abortion, this dissertation used Interpretive Phenomenological Analysis and a cultural and religious lens to explore the decision-making processes and phenomenological experiences of four young Mexican-American women who elected to terminate their first pregnancy. Results indicated that the women in this study believed abortion was unique, and more difficult for Mexican-American (and other Latina) women, given cultural and religious norms that specifically prohibit abortion and simultaneously prioritize sexual purity, responsibility, and motherhood for women. The complexity and difficulty inherent in navigating overlapping and oftentimes contradictory sociocultural and religious values are discussed as they relate to the participants' abortion decision and experience. The manuscript concludes with strengths and limitations of the present study, suggestions for future research, and implications for psychologists. Keywords: Mexican, Latina, Abortion, Reproductive Health