Understanding the history of the Israeli-Palestinian conflict is important for a greater understanding of the current state of sexual and reproductive rights of Palestinian women. Constant military occupation has been a determining factor hindering the development of comprehensive and coherent health policies and programmes. As a result of the Oslo Accords and the Israeli-Palestinian Interim Agreement in 1994, the Palestinian National Authority was granted limited authority over portions of the West Bank and Gaza. In 2007-2008 a multi-national, multi-disciplinary study team undertook a national study to assess the reproductive health content of nursing education and identify gaps in curricular coverage and implementation. One component of this project included exploring final year nursing and midwifery students’ attitudes toward a range of sexual and reproductive health issues. This thesis analyzes these data and explores the demographic factors, including gender, region, and residence, associated with nursing and midwifery students’ attitudes toward abortion and contraception-related laws and policies. Our findings suggest that there is a considerable need to incorporate values clarification exercises as well as structured sessions dedicated to laws and policies governing sexual and reproductive health into the formal curricula of programs in both the West Bank and the Gaza Strip. Our results also shed further light on the dynamics shaping abortion and contraception attitudes among health professions students in the Occupied Palestinian Territories.

This ethnographically informed dissertation focuses on the ways rural Yucatec Maya women, midwives and state health care workers participate in the production of childbirth and maternal health care practices. It further addresses how state health programs influence the relationships and interactions between these groups. Although childbirth practices in Yucatan have always been characterized by contestation, negotiation and change, their intensity and speed have significantly increased over the last decade. Drastic changes in the maternal health of rural indigenous communities in Mexico and throughout the world are directly connected to intensified state interventions that favor biomedicine over traditional health systems. In rural Yucatan, state health programs such as Oportunidades and Seguro Popular support a biomedical approach to birth by distributing medical resources to government clinics/hospitals and encouraging program participation of poor women through conditional cash incentives. This dissertation seeks to interrogate changing childbirth practices in a rural indigenous community in Quintana Roo, MX to gain a deeper understanding of the complex politics that shape local understandings and approaches to childbirth. It further explores how shifting social relations and political alliances are created within the context of reproductive health. This ethnography highlights how Yucatec Maya women envision a productive, yet negotiated, relationship with the state that allows them control of their prenatal and maternal health while engaging with state health programs. Focusing on the cultural production of childbirth in a rural community in southwestern Quintana Roo, this research seeks to explore the dynamic ways in which indigenous communities are reproduced over time through moments of engagement and contestation with the state. The Maya women in this dissertation exist at the margins of the Mexican government’s concerns, policies, and resources. Yet, even at the margins the influence and power of state ideology and policies intimately affect the lives of rural indigenous women. The core argument of this dissertation is that these women, who rely on traditional and historical experience, create strategies for survival and social reproduction despite their marginalized position within the Mexican state. This research draws from over a decade of fieldwork. Predissertation fieldwork took place during the summer months of 2002, 2003, 2004, 2007, 2008, and 2010. I completed my dissertation fieldwork from January to October of 2013. During that time, I conducted 60 formal and informal interviews and a small survey. Additionally, a large portion of my research took place with a local family that consisted of female healers and health educators, whom I extensively interviewed and conducted hundreds of hours of participant observation. The family was the locus of authoritative knowledge in the community and they provided vital insights into community life and local understandings and approaches to reproductive health. This dissertation follows the Latin American tradition of using testimonios to articulate—and reflexively examine—the layered meanings and intersecting politics that shape changing childbirth practices in rural Yucatan.

Magister Public Health - MPH / This study analyses media representations of Female Genital Mutilation/Cutting (FGM/C) in two Ugandan daily English newspapers. FGM/C is recognized by the World Health Organization as an extreme form of violation of the rights, health and integrity of women and girls. In Uganda, although the overall prevalence of FGM/C is 0.3 percent of the population, FGM/C remains a harmful practice that constitutes a serious threat to the health of women and girls in communities that practice it. Despite existence of a national legal and policy framework that discourages FGM/C, progress in the eradication of the practice remains slow.

This thesis sets out to investigate if the proportion of women in the national parliament correlates with the extent to which national laws and policies guarantee women's sexual and reproductive health and rights. By conducting a cross-national comparison, this thesis contributes to the existing literature by offering an analysis of the relationship, utilizing a comprehensive measurement of states national legal and regulatory framework relating to women's sexual and reproductive health and rights. Further, it aims to offer an analysis of how the relationship appears in different regime-types, including both democratic and non- and partial democratic states. The results did not provide any support for a correlation between the proportion of women in the national parliament and the extent to which national laws and policies guarantee women's sexual and reproductive health and rights, regardless of the regime-type. While the results are inconsistent with the predictions of a correlation, this thesis is able to conclude that the concept of women's representation and how it may be connected to substantial changes in national legislation and policy is a complex relationship, worthy of further research.

Little is known about the factors that influence people from the Caribbean to seek reproductive health services in the United States. In this paper, I focus on Indo-Caribbean women from Guyana and Trinidad who undertake reproductive journeys to New York. I ask: (1) What influences Indo-Caribbean women to begin their reproductive journeys to Richmond Hill, New York? (2) How do Indo-Caribbean women challenge gender norms during their reproductive journeys? (3) How does women’s class inform their decision making in challenging gendered norms? After conducting 30 in-depth interviews with Indo-Caribbean women from Guyana and Trinidad who seek reproductive health services in New York, I find that Indo-Caribbean women’s reproductive journeys are influenced by sexism experienced within households, communities, and doctors’ offices, lack of proper care, legal restrictions, and unaffordable treatment. Another driver is support from women networks. Social networks helped women challenge gendered norms around motherhood that are present within communities in home countries. As women receive support from their networks, they challenge gender norms varied by their class. Women from middle-income households are more likely to challenge gender norms outwardly. Obtaining reproductive health care abroad becomes a journey with multidimensional experiences of gendered negotiations and constraints.

This dissertation describes the patient experience. In Chapter One, we review the currentstate of patient-centered care with a specific focus on women’s experiences in infertility treatments, highlighting the gaps in our understanding of their experiences. The four independent but complementary aims of the dissertation studies are then introduced, and we identify how they address current gaps to advance our understanding of women’s experiences using reproductive technology. In Chapter One, we also introduce an innovative service design tool, journey mapping, as well as the Burden of Treatment Framework which guided the dissertation. Chapter Two, An Integrative Review of Journey Mapping to Document the Patient Experience, presents an integrative review examining the use of journey mapping in health care services research. In the analysis of these twenty-two studies, we demonstrate how journey mapping has been adapted to describe the patient experience. While the qualitative rigor of the included studies is of good quality, the inconsistent application of design standards in the accompanying visualizations, when present, suggests that further work and guidance is needed in the adaptation of this service design tool for the health research field. In Chapter Three, Journey Mapping the Patient Experience of IVF: A Social Media Analysis, we used posts from the largest infertility subreddit and patient-facing online resources to describe and visually depict the patient experience of IVF in two journey maps representing the experiences of women in their first cycle of infertility treatment and women in repeat cycles. Findings highlighted problems and unmet needs in the infertility treatment experience, including information needs, communication needs, and support needs. Chapter Four, The Burden of Treatment in IVF: An Analysis of Social Media Using a Framework for Chronic Complex Conditions, used qualitative descriptive methodology to guide inductive and deductive content analysis of posts from the same infertility subreddit. Findings suggest that Eton’s framework is applicable to infertility, but can be expanded by the inclusion of three new constructs that we identified. Finally, Chapter Five synthesizes the key findings across these four aims, outlining their strengths and limitations, and discussing implications for future research, policy, and clinical practice.

Cesarean delivery has notably increased around the world during the last three decades. Globally, the proportion of birth by cesarean delivery is higher in countries with higher levels of socioeconomic development, higher female enrollment in secondary education, higher levels of urbanization, greater density of physicians, and lower fertility. Additionally, cesarean rates are consistently higher in private than public health facilities in all regions of the world. Latin America and the Caribbean is the region with the highest cesarean rates globally and Dominican Republic is the country with one of the highest rates of cesareans worldwide. This research focuses on factors associated with cesarean delivery in Latin America and the Caribbean with an emphasis on Dominican Republic and is presented in three interconnected papers. The first paper, entitled “Determinants of cesarean delivery in Latin America and the Caribbean: a scoping review” identified factors associated with the escalating rates of cesareans in the region by mapping the literature on social determinants, women’s preferences, and healthcare providers’ attitudes and beliefs towards cesarean delivery. Thirty studies conducted between 2009 and 2019 met the inclusion criteria for the scoping review. Cesarean delivery was positively associated with older maternal age, higher maternal education, higher household income or wealth, urban residency, and delivering at a private health facility. Other factors such as ethnicity and marital status were less consistently assessed in the studies. Many studies evaluated social determinants of cesarean as covariates in multivariate analysis but did not evaluate them as the primary association, hence the impact of those determinants in cesarean delivery remains understudied. Women’s beliefs and providers’ attitudes were found to influence cesarean rates; however, detailed evidence on individual incentives is still limited. The second paper entitle “Relationship between mode of delivery and type of health facility in Dominican Republic: an analysis of the Multiple Indicator Cluster Survey” is a secondary data analysis of a population-based survey that evaluates differences in the determinants of cesarean delivery in public and private healthcare facilities. Among a sample of 4,398 women who delivered at a healthcare facility, cesarean rates were 48.1% and 86.5% in public and private hospitals respectively. In public hospitals, cesareans were associated with older maternal age, higher education, higher quintile of wealth, and Catholic religion. After adjusting for confounders, no associations were found between sociodemographic factors or maternal health characteristics and cesarean delivery in private hospitals. This study underscores the need to study other drivers of cesareans, particularly in private hospitals. The third paper entitle “Factors associated with cesarean delivery across maternal age groups in Dominica Republic” examines the differences in factors associated with cesarean delivery in adolescents, younger, and older women. Cesarean rates were 52.6%, 59.6%, and 71.0% in women aged <20, 20-34 or 35-39 years old respectively. Overall, there were no differences in the odds of cesarean delivery between adolescents and women aged 20-34. Women aged 35 or older were more likely to have a cesarean delivery than women aged 20-34. In women 20-34 years old, education, Catholic religion, and wealth were associated with cesareans. In women >=35 years, education and wealth were associated with cesarean delivery. Delivering at a private hospital increased the odds of cesarean delivery across the three age groups. The objective of this dissertation is to contribute to the literature with evidence to inform programs, policies, and practice and to highlight opportunities for further research on determinants of cesarean delivery in Latin American and the Caribbean, and particularly in Dominican Republic.

'Leaving no one behind' is the slogan for strategies and action plans. Goal 3 of the Agenda aims to "Ensure healthy lives and promote being for all at all ages" which includes sexual and reproductive health. However, it leads ther the policy frameworks are leading to the goal of 'leaving no one behind'. In order to answer the question, migrants' rights is one of them. The construction of the inequalities in the discourse will be

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: Polycystic Ovary Syndrome (PCOS) is a reproductive and endocrine disorder common among women of reproductive age. It is characterized by elevated androgen levels, menstrual irregularities, and several cysts ranging from 2 to 9 mm on one or both ovaries. PCOS is prevalent in approximately 10% of women typically between the ages of 18-44. It is significantly underdiagnosed due to variation in disease manifestation. Treatment for PCOS includes oral contraceptives, Metformin, and Spironolactone. However, supplements such as zinc and magnesium are increasingly promising additions to PCOS treatment regimens to manage symptoms and co-morbid chronic diseases. The objective of this thesis is to determine the prevalence of supplement use as a treatment for PCOS in the Ovulation and Menstruation Health Pilot Study (OM). The OM Pilot study is an epidemiological, online survey that aims to study the characteristics and determinants of female reproductive diseases in a diverse population. This thesis also explores the overall role of nutrition in PCOS management. METHODS: The goal of the OM Pilot Study is to determine women’s gynecological health outcomes in a multi-ethnic cohort and to characterize the lifestyle, health, and menstrual risks of reproductive diseases such as polycystic ovary syndrome, endometriosis, and uterine fibroids. The eligibility criteria included: being of reproductive age, having the ability to menstruate, being able to read in English, and having a working email address to receive the link to the survey. The survey and questions were designed by a board-certified reproductive endocrinology and infertility specialist at Boston Medical Center and was administered through REDCap, a cloud-based clinical software application for building and managing online surveys and databases. The questionnaire was comprised of each of the following sections: Demographics, Baseline Questionnaire, Anthropometrics, Menstrual Cycle, Contraceptive History, Health and Body, Polycystic Ovary Syndrome, Reproductive Health Questions, General Health Questions, Diet and Lifestyle, and Pregnancy and Birth History. Participants were recruited from multiple cities across the United States using in-person recruiting methods, online recruitment through a link, flyers, posters, word-of-mouth, and advertisements on Facebook and other social media websites such as Twitter and LinkedIn. Consenting participants were entered into a raffle to win a $200 gift card. Data analysis was conducted on SAS 9.4 and manually as needed. RESULTS: In terms of prevalence of PCOS: Of the 249 women who completed the survey, 60 women self-reported to having polycystic ovary syndrome (37 were diagnosed by a physician and 23 diagnosed by self). And of those 60 women who reported having PCOS, 24 reported taking medication for PCOS and out of these women, 10 women reported taking one, two, or three of the supplementary treatment options. Of the 60 women with PCOS, 4 women currently take a multivitamin for PCOS, 2 women currently take a dietary supplement, 2 women currently take herbal remedies, and 4 women reported drinking spearmint tea to help with PCOS management. Additionally, out of the 60 women who reported yes to having PCOS whether they were diagnosed by a physician and self-diagnosed, 11 women also reported yes to having an eating disorder. Of those 11 women, 7 women have anorexia, 7 women have bulimia, and 4 women have binge eating disorder. CONCLUSION: In this thesis, the prevalence rates of PCOS diagnoses, supplement use among PCOS patients, and eating disorders among PCOS patients were determined. Based on current literature on the effectiveness of supplements on PCOS symptoms, it seems advisable to study the effects of supplements further to incorporate them into treatment. With additional research, medical personnel such as physicians and registered dietitians should consider adding supplements to treatment regimen for PCOS. A personalized diet and exercise plan along with a plan to treat mental health to curb the prevalence of eating disorders may be beneficial to add to the treatment regimen for PCOS.