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.

Termination of pregnancies is a public health concern in many developing countries. In Bangladesh women faces barrier to access health care service for pregnancy termination. Moreover induced termination is illegal, against religion and moral grounds therefore, many pregnancies termination performed by untrained and unsafe way in Bangladesh which leading to maternal morbidity and mortality. On the other side, unintended pregnancy termination such spontaneous abortion, miscarriage occurs due to disease, trauma, genetic defect or biochemical incompatibility of mother and fetus and climate change related vulnerabilities. This study investigates the prevalence and associated factors of terminated pregnancy among Bangladeshi ever-married women. Secondary data was obtained from Bangladesh Demographic Health and Survey (BDHS) for the year of 2017-18. Data was included 20127 samples of ever-married women of reproductive age 15-49 year. Descriptive analysis (chi-square test) and one way- ANOVA (Analysis of Variance) test was conducted to understand the association between factors and pregnancy termination. The study finding revealed that 21% ever-married women had terminated pregnancy and there were statistically association between terminated pregnancy and demographic, socio-economic and reproductive health related factors. Termination of pregnancy is prevalent in Bangladeshi women and need to apply health policy for preventing and intervening programme to eliminate geographic and socio-economic inequalities. For example, providing education and counselling program about reproductive health care service and family planning method help to avoid unintended or unsafe pregnancy termination.

TITLE: Motherhood of Under Age Girls AUTHOR: Pavla Skasková DEPARTMENT: Department of Psychology SUPERVISOR: PhDr. PaedDr. Anna Kucharská, Ph.D. The dissertation is focused on phenomenon of motherhood in adolescence. In the Czech Republic nearly one thousand children are given birth every year by mothers who according to current law are not full-aged. A very similar number of teenage girls decide for abortion. The study searches for answers to broad varieties of particular research questions. Qualitatively directed research outcomes reflect motives involved in young women's final decisions to become an under-age mother, the determinants of the decision making process in the context of sexual reproductive health. They watch as the participants prepare for the role of mother, what helped them solve the situation and what is it difficult to evaluate their experience and maternity and parental competence. The work focuses on the reflected experience of the new role in the self, and the identity of teenage mothers. A semi-structured interview was chosen as the fundamental method to gather the data; however, additional essays of all respondents are available as well. There is analyzed the data of 28 participants, under-age mothers, who are allocated with their children in an institutional care or in...

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Unauthorized reproduction of this article is prohibited. Objective: The role of local health departments (LHDs) as a clinical service provider remains a salient topic of discussion. As local and state health departments continue to migrate away from clinical services, there is need to understand the impact on these transitions on access to care in a given community. The purpose of this study was to examine the impact of clinical capacity reductions in LHDs on receipt of annual family planning visits among South Carolina women. Design: A rolling panel of women eligible for Medicaid between 2001 and 2012 was created. Receipt of an annual visit for each year of Medicaid eligibility was tracked over time. A typology reflecting changes in county capacity for clinical services was used as the independent variable. We estimated multivariate generalized estimating equation models, which examined changes in population-averaged probabilities (marginal means) of annual family planning visits over time by level of county typology. Results: Approximately 325 269 unduplicated women were included in the panel, with 25.18% receiving an annual visit in a given year. On average, receipt of annual visits in counties with notable reductions in LHD clinical capacity tended to be fewer over time (-0.022; 95% CI [confidence interval],-0.028 to-0.017) as among counties with reduced capacity that included a specific clinic closing (-0.032; 95% CI,-0.037 to-0.028). However, the magnitude of observed differences between county typologies was relatively small. Conclusions: Evidence of service discontinuity was present. However, differences occurred later in the study period following the economic recession. Our findings suggest that counties that reduced capacity did not lose ground but were unable to meet increasing demand from the economic recession relative to those that did not reduce capacity even when closing a clinic. As LHDs discontinue or significantly reduced clinical services, fulfilling the assurance role is important for transitioning women to other sources of care.

Human papillomavirus is the most frequently occurring sexually transmitted infection and has been recognized as the necessary cause of cervical cancer. Understanding the shift in public awareness caused by recent changes to cervical prevention is critical to addressing cervical cancer disparities in Appalachia. Since the human papillomavirus vaccine was approved for prevention, little data have been collected regarding human papillomavirus risk assessment and vaccine perceptions among Appalachian women. The purpose of the authors in this study was to investigate communication and cultural issues via a social scripting framework that could influence human papillomavirus vaccine uptake among southern Appalachian women; and explore participants' perceptions of human papillomavirus, cervical cancer, and the vaccine. A qualitative, descriptive design was employed to examine these issues in eight counties in northeast Tennessee and southwest Virginia. Thirty-nine women aged 18-49 years participated in a single individual interview or focus group session from October 2007 through August 2008. Interview and focus group data were audio-taped and transcribed verbatim. Two major themes emerged from the data: the human papillomavirus vaccine protection dilemma and spheres of silence surrounding the human papillomavirus vaccine protection dilemma. Study findings suggested areas for future research and may assist healthcare professionals in approaching southern Appalachian women as they make decisions regarding cervical cancer prevention.

Objective: State medicaid programs provide access to effective contraception for people with lower incomes. This study examined contraception use and pregnancy among reproductive-age women enrolled in the South Carolina Medicaid, by eligibility program and socio-demographic sub-groups. Methods: A retrospective cohort of women aged 15–45 who were newly eligible for South Carolina Medicaid from 2012 to 2016 was examined. Log-binomial regression and average marginal effects assessed relationships between contraception use and pregnancies ending in live and non-live births. Contraception was categorized as permanent, long acting reversible contraception (LARC), short-acting hormonal contraception (SAC), or no contraceptive claims. Women with family planning or full-benefit medicaid coverage were included. Results: Approximately 11% of women used LARC methods, 41% used SAC methods, and 46% had no evidence of contraceptive claims. Method utilization varied by eligibility program, race/ethnicity and age. The likelihood of pregnancy was lower among SAC users and lowest among LARC users compared to women with no evidence of contraception across all three programs (family planning APR = 0.44; 95% CI 0.41–0.49 and APR = 0.13, 95% CI 0.10–0.17; Low income families APR = 0.82; 95% CI 0.77–0.88 and APR = 0.33, 95% CI 0.28–0.38; Partners for Healthy Children APR = 0.72; 95% CI 0.68–0.77 and APR = 0.35, 95% CI 0.30–0.43, respectively). Non-Hispanic Black and Hispanic teens were less likely to experience a pregnancy than non-Hispanic white teens. Conclusions for Practice: The likelihood of pregnancy was lower among women using SAC methods and markedly lower among women using LARC. Variation in contraceptive use among racial/ethnic groups was noted despite Medicaid coverage. As new policies and initiatives emerge, these findings provide important context for understanding the role of Medicaid programs in reducing financial barriers to contraceptive services and ensuring access to effective contraception, while fostering reproductive health autonomy among women.

Modern methods of contraception are freely available in Albania, yet contraceptive prevalence among Albanians is relatively low (11%). Abortion on the other hand has long been the mainstay of family planning in the country. Emergency contraception is not very popular in Albania either, even though two different levonorgestrel-only EC pills (NorLevo® and Postinor®) are widely available in Albanian pharmacies. This study aimed to investigate potential factors that influence women’s choices of contraception. In 2016, we conducted a multi-method qualitative study with women and service providers in Albania. Women were invited to report their knowledge of, attitudes toward, and practices surrounding contraception in an online survey. Also, we conducted in-depth semi-structured interviews with key informants to better understand the current reproductive health landscape in the country. Additionally, we conducted structured interviews with pharmacists in Tirana to assess their training and practices with regard to different available contraceptive methods. Misinformation, lack of awareness, fear of judgement and embarrassment, and lack of infrastructure are the strongest influencers of women’s choice of contraception in Albania. Training of health service providers, as well as development of materials for distribution are warranted to improve knowledge and uptake of contraception among women.

Magister Artium (Development Studies) - MA(DVS) / Background: Sexual and reproductive health (SRH) is a right that should be guaranteed to every woman worldwide in order to have a healthy and safe sex life. In most Arab countries, including Egypt, there are different cultural, political, and religious factors that have contributed significantly to the manner that the society views and treats women’s bodies and sexuality. As a result, it is difficult to provide solid data and information to guide policymakers, policies, and to implement awareness and preventive programs. This thesis sought to address this gap by conducting a study looking at the intersectionality of women’s access to sexual and reproductive health services and information in Ismailia, Egypt. Methods: The relevant information was collected using qualitative methods. Semi-structured interviews were conducted with twelve married women and two key informant interviews with health professionals in the study area. Results: Intersectional theory was used to critically examine the various interacting factors such as gender, patriarchy, economic disadvantages, and other discriminatory systems that that can undermine women’s access to SRH information and services. The study revealed that married women suffer from the lack of access to proper SRH services and information. Conclusion: Married women’s experiences of accessing SRH services and information were affected by different intersecting factors. These factors are socio-economic, policy, cultural norms, power structure contexts, and privilege structures, and religious institutions. Recommendations were drafted to add more information and evidence related to Egyptian women and their SRH rights.

Uganda currently hosts 1.4 million refugees and conflict-affected people. Known as the “best place” in Africa to be a refugee, Uganda’s policies encourage self-sufficiency and local integration. However, many refugees, particularly women and girls, face persistent challenges. Understanding the reproductive health needs of this population and exploring the accessibility of services for conflict-affected populations in this low-income host country is a priority. This multi-methods study aimed to assess the reproductive health needs of displaced Congolese women in camp- and urban-based settings in Uganda. We interviewed key informants, facilitated focus group discussions with refugee women, and conducted in-depth interviews with Congolese women of reproductive age to better understand knowledge, attitudes, practices, and services. Our results suggest that Congolese refugees have significant unmet reproductive health needs. Maternal health and delivery care is characterized by insufficient human resources, inconsistent medication availability, discrimination, bribery, and communications challenges. The availability of contraceptive products, including emergency contraception, is limited in camp-based settings due to supply-chain management challenges and theft by staff; lack of contraceptive knowledge among Congolese refugees shapes use. Finally, the legal restrictions on abortion lead to unsafe practices among refugees and pose a barrier to the provision of post-abortion care. This study provides insight for opportunities to improve the delivery of sexual and reproductive health services to refugees in Uganda to ensure that the infrastructure and processes align with national policies and international guidelines.