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PROBLEM STATEMENT: Globally, 70% of more than three million new curable sexually transmitted infections (STI) are among 15-24 year olds, with young people in developing countries bearing the highest burden. Chlamydia Trachomatis prevalence, for example, is 15.4% and 20.5% in young women and men attending STD clinics in the U.S. However, Caribbean STI data for young men are particularly scarce and inconsistent and cases are under-reported due to poor health seeking behavior. In Guyana, 42% of the STI cases from 2010 -2014 occurred in young people, aged 15- 24. Moreover, few programs and policies focus specifically on the sexual and reproductive health (SRH) needs of young men. This dissertation explores the contextual and behavioral factors that cause young men’s vulnerability to STI and proposes recommendations for the national response in Guyana. METHODS: Research methods included: 9 focus group discussions (FGDs) with young men, aged 15-18, mothers and fathers and 25 in-depth interviews with representatives from government, community, faith-based and donor organizations. Interviews and FGDs were audiotaped, transcribed, and analyzed for major themes among and across each stakeholder group. Analysis was guided by a socio-ecologic framework and resulted in program and policy recommendations to address vulnerability to STI and augment protective factors against STI in young men in Guyana. RESULTS: Salient overarching themes include: Poverty and Disenfranchisement “Yes, this is a Man”: Early Sex, Fast Money, and Risk”, “The Empty Room: Young Men without Male Roles Models”, “Sex in a violent society”, “Stigma, Discrimination, and Shame: Road blocks to young men’s sexual health” and Young men’s Sexual and Reproductive Health: Young men’s Sexual and Reproductive Health: It all depends on family, religion, education, music and media (or not). Participants highlighted a lack of SRH awareness and health care seeking resulting from insufficient male SRH promotion and services. Parental engagement, school attendance, supportive peers, religious commitment and internet use for SRH information were described as protective factors. CONTRIBUTION: A socio-ecological model helped to comprehensively identify and organize broad social determinants of SRH and high risk sexual behaviors for young men. The resulting program and policy recommendations are proposed for implementation in Georgetown, Guyana. / 2018-11-08T00:00:00Z

Obstetric violence includes acts of abuse, coercion, or disrespect that occur during the labor process. The present study explores how obstetric violence impacts a person’s postpartum psychosocial adjustment. This study used a subset of data (N = 339) from a larger online study, which attempted to explore multiple facets of a person’s postpartum health. The psychological constructs examined are postpartum depression and postpartum anxiety. Additional constructs assessed were protective and risk factors: self-compassion and medical mistrust. Self-compassion and medical mistrust were examined by using moderation models. Additional analyses were completed using simple regression models to explore whether obstetric violence predicts either postpartum anxiety or postpartum depression. Results yielded non-significant moderations for all constructs; however, obstetric violence predicted both postpartum anxiety and postpartum depression. This study was the first to examine how self-compassion and medical mistrust relate to the onset of postpartum anxiety and depression following an experience of obstetric violence.

Estimates suggest that about eight million American teens and young adults experience clinical symptoms of mental illness. For many, these mental health challenges will develop into a diagnosable and potentially life-long psychiatric disorder. Together they form a large population of adults who enter their prime reproductive age as psychiatric patients. Though individuals with mental illness enjoy the same reproductive rights as those without psychiatric conditions, social and medical discourses often portray their parenthood as risky and undesirable. Women with mental illness are in a particularly difficult position. As women, they are subjected to the gendered expectation that they become mothers. Yet at the same time, their mental illness results in their motherhood being frowned upon. Carrying these contradicting values, this study asks how women with psychiatric disorders make reproductive decisions. Do these women think of their reproductive capacity through the psychiatric framing of risk, or through gendered narratives of desired motherhood? Using open ended interviews with women with a psychiatric diagnosis, this study shows that women with mental illness approach their reproductive decision-making by utilizing narratives of both normal reproduction and disability. Some women portray their mental illness as an obstacle to motherhood while others create a separation between their mental and reproductive health. Still others defy the distinction between psychiatry and normalcy and describe their reproduction as a way to bring the two together. Despite the difference in framing, all the women in this study engage with the discourse of risk(s) that is brought on by their mental illness. To weigh risk and act upon it, they visit their and their peer’s biographical stories of illness, assess their fitness into normative ideas of good motherhood, and evaluate the worth of medical and scientific information. They question the way medical information is created, distributed, and made applicable to the idiosyncrasy of their reproductive life. In doing so, these women draw boundaries around trust as well as redefine medical neutrality. Finally, we show that women with mental illness and their health providers rely on a vaguely defined stepwise plan to approach reproduction. This plan brings normativity – and desirability - to their reproduction at the same time that it threatens to exclude them from motherhood. By bringing these arguments together we arrive at the overall conclusion that women with mental illness do not approach their reproduction as a monolithic group. Nor do they organize along diagnosis lines. This study shows that women across psychiatric diagnoses share similar reproductive desires, some hoping to have children and others wishing to avoid motherhood altogether. The popular idea that certain psychiatric diagnoses render women unsuitable for motherhood is not echoed by the women in this study. Instead, their embodied experience of mental illness allows them to embrace the newfound reproductive choice of psychiatric patients and highlights the stigma that perpetuates fears of motherhood with mental illness.

Every year, approximately 21 million girls aged 15 to 19 living in low- and middle-income countries (LMICs) become pregnant and over 12 million of these girls give birth. Complications from pregnancy are the leading cause of death for girls aged 15 to 19 in LMICs and adolescent mothers face an elevated risk of life-long morbidities due to pregnancy and childbirth. The risk of early childbearing and its associated consequences vary significantly depending on age, socioeconomic status, and place of residence. Adolescents affected by conflict or natural disasters are often recognized as one of the most vulnerable groups in this regard; among the countries with the highest adolescent birth rates globally, most are affected by conflict or fragility. This dissertation aimed to fill a critical gap in the literature on adolescent pregnancy in humanitarian settings. The three studies in this dissertation utilize qualitative and quantitative research to better understand the myriad drivers of adolescent pregnancy and, in the context of protracted conflict in Democratic Republic of the Congo (DRC), how exposure to armed conflict may or may not modify certain risk and protective factors. The findings of this dissertation confirm that risk and protective factors for adolescent pregnancy are numerous, interrelated, and complex; preventing early and unintended pregnancy requires multi-level interventions that build the protective assets of adolescents while also engaging with male partners, parents and caregivers, and community members. The research deepens this understanding by demonstrating the extent to which long-standing and deeply rooted sociocultural norms influence adolescents’ individual and inter-personal behaviors in diverse contexts, including settings affected by armed conflict. Thus, instead of considering how standalone risk and protective factors for adolescents differ depending on the context, the research highlights the importance of understanding linkages between environmental, inter-personal, and individual factors and the pathways through which these linkages influence reproductive health decision-making among adolescents. This dissertation also provides new evidence as to how the presence of armed conflict does not uniformly influence risk and protective factors for adolescent pregnancy. Instead, it finds that, in the case of DRC, underlying social norms and differences in social, demographic, and economic characteristics outweigh the effect of armed conflict on incidence of adolescent pregnancy. This finding does not mean that armed conflict does not have any impact on adolescent pregnancy; rather, it confirms the need for continued research in different humanitarian contexts and informs how to apply best practices from development settings to improve sexual and reproductive health (SRH) outcomes among adolescents affected by humanitarian crises. Meeting the SRH needs of adolescents requires going beyond service provision and understanding the numerous, interrelated risk and protective factors that exist at the individual, inter-personal, and community levels. Situations of conflict and displacement may present additional complexities for understanding and meeting the SRH needs of adolescents. However, this dissertation shows the feasibility of conducting research and utilizing existing data to understand some of the root causes of adolescent pregnancy in a conflict-affected setting. Moreover, the studies highlight how more robust evidence can challenge some of our longstanding assumptions about adolescents affected by humanitarian crises. Continued rigorous research and taking the time to listen to adolescents and their communities can lead to more responsive adolescent SRH programs and services that contribute to adolescents’ healthy transitions to adulthood.

Ongoing global health inequities have been amplified since the 2020 COVID-19 pandemic and subsequent social movements. Such inequities have resulted in increased literature critiquing the historical roots and current practices in global health. From this literature, questions have emerged about the future of global health and Canada’s role in this future. However, there is little research consolidating existing critiques and, based on these critiques, exploring adolescent sexual and reproductive health (ASRH) research and the role of Canadian funding for ASRH. The aim of this dissertation is to consolidate contemporary critiques of global health to develop a conceptual framework for one potential imagined future for global health. It then explores the conceptual framework for an imagined future through an example of global health research, policy, and practice, as it relates to ASRH in Eastern sub-Saharan Africa, to consider the opportunities and challenges of achieving this new potential vision. In this dissertation, I present four unique contributions. The first article presents the conceptual framework for an imagined future that will be used to explore ASRH research, policy, and practice. The second article presents findings from a scoping review on adolescent engagement in ASRH research. The third article presents a review of Canada’s Feminist International Assistance Policy (FIAP) and examines the development of the policy in relation to an imagined future. The fourth article presents a qualitative description of stakeholder perspectives who are implementing ASRH projects with Canadian funding and discusses these perspectives in relation to an imagined future. Conclusions suggest that language to support changes towards an imagined future in global health exists although there is continued opportunity to operationalize the changes. Further research is encouraged to engage local actors and consider practical ways to shift towards equity and justice in Canadian funding for ASRH. / Dissertation / Doctor of Philosophy (PhD) / There is growing controversy in the field of global health and it is not yet clear how the field will respond and evolve. As the number of critiques grow, responding with new ideas for the future of global health becomes more urgent and yet more difficult. This thesis aimed to address this challenge by examining what an imagined future for global health research, policy, and practice might be, and how it might be achieved. This research focuses on the future of global health and Canada’s role in it, particularly regarding adolescent sexual and reproductive health (ASRH) in Eastern sub-Saharan Africa. By reviewing documents and conducting qualitative interviews, this study explores adolescent involvement in ASRH research, Canada’s Feminist International Assistance Policy (FIAP) and stakeholder experiences implementing ASRH projects with Canadian funding. Findings emphasize the need for concrete actions to implement the changes proposed by scholars. Further research is encouraged to engage local actors and consider practical ways forward for shifts towards equity and justice in Canadian funding.

Background: A significant amount of research has previously been conducted in developing countries such as India, to improve women’s sexual and reproductive health. However, women living in North Indian slums still have poor access to proper sexual and reproductive healthcare. The aim of this thesis is to investigate the published literature to create a consolidated understanding of the key barriers faced by women in slum populations when accessing sexual and reproductive health services in Northern India. Methods: A scoping review was carried out following the five stages outlined in Arksey and O’Malley’s framework. Five online databases (MEDLINE, Global Health, Ovid Emcare, Embase, and Web of Science) were searched. An interpretive thematic analysis was conducted to extract meaningful themes from the data using the Conceptual Framework for Reproductive Empowerment developed by the International Center for Research on Women Results: In total, 28 articles were identified to be incorporated into the scoping review. The results of this study were grouped according to the CFFRE to understand how they compared in regard to women’s reproductive empowerment. This scoping review found reproductive empowerment was significantly hindered by women lacking a proper education and understanding of SRH services, lack of employment and financial resources. Additionally, women’s husbands and mothers-in-laws were barriers to contraceptive use. Finally, poor interactions with healthcare providers and the healthcare system, and systemic factors such as behaviours in treatment seeking, son preference and religion were barriers to accessing SRH services. Conclusion: This scoping review investigated the barriers faced by women living in slum populations in Northern India to accessing SRH services. The results of this study contribute to the literature by identifying areas that require improvement to SRH services for women living in slums, and will be integral to implementing strategies and interventions to allow better access to SRH services in the future. / Thesis / Master of Science (MSc) / A significant amount of research has previously been conducted in India, to improve women’s sexual and reproductive health. However, women living in North Indian slums still have poor access to proper sexual and reproductive healthcare. Therefore, this study investigated the key barriers faced by women in slum populations when accessing sexual and reproductive health services in Northern India. A review of previous studies was conducted by searching five electronic databases and a total 28 articles were included into the review. This study found that women lacking a proper education and understanding of SRH services, lack of employment and financial resources, and women’s husbands and mothers-in-laws were barriers to SRH services. Finally, poor interactions with healthcare providers and the healthcare system, and systemic factors such as behaviours in treatment seeking, son preference, and religion were also barriers to accessing SRH services.

<p>  </p> <p>Can a reproductive health organization address the history of eugenics with 140 characters and some emojis? Can a 10 second video establish the link between abortion access, child protective services, and prison abolition? This dissertation explores the framing – the use of narratives, symbols, and discourse used to motivate collective action – in social media posts social movement organizations (SMOs) in the reproductive health field. I ask: How do organizations frame the past and how does the past influence contemporary frames? While the organizations in my study share a field, they do not necessarily share the same collective memory of that field. Instead, organizational depictions of time and history may be divided across racial lines. Using SMOs’ social media posts on Instagram, I look at six reproductive health SMOs, three historically white (HW) and three POC-led. I use quantitative and qualitative analyses to explore differences in framing by organization type in my 1,200 Instagram post dataset. While all the organizations broadly claim inclusivity I hypothesize differences in framing around the past, legal rights, and threat. My work shows, both quantitatively and qualitatively, there are variations between HW and POC-organizations both in what frames are used and who is centered in those frames. I find HW-organizations are more likely to use rights framing, encourage participation in formal political institutions, and focus on inclusion along a single axis. In comparison, POC-organizations are less likely to use rights frames or call for formal political actions. They are more likely to encourage protest actions, highlight threats outside of legal restrictions, and center marginalized groups using an intersectional lens. I conclude that organizational understandings of temporality constrain historically white organizations’ capacity for intersectional solidarity and undermine POC-led organizations tactics, framings, and goals. Understanding frame variation across organizations in this field has broader implications for diversity, solidarity, and sustainability within social movements more broadly.</p>

The study sought to assess the knowledge of adolescents regarding abortion in a selected area in Lagos Nigeria. The researcher used a non-experimental, exploratory, descriptive research design for the study. One hundred adolescents participated in the study. The study found that many adolescents will not admit to having had an abortion. Moreover, the respondents gave different meanings for abortion, had inadequate knowledge of abortion and sexual and reproductive health. Cultural taboos and religious beliefs have a great impact on adolescents’ sexual behaviour. Most adolescents would not access abortions services because they regard it as killing an innocent baby. Efforts should be strengthened to make contraceptives and family life education available and accessible to the adolescents. / Health Studies / Thesis (M.A. (Health Studies))

The study sought to assess the knowledge of adolescents regarding abortion in a selected area in Lagos Nigeria. The researcher used a non-experimental, exploratory, descriptive research design for the study. One hundred adolescents participated in the study. The study found that many adolescents will not admit to having had an abortion. Moreover, the respondents gave different meanings for abortion, had inadequate knowledge of abortion and sexual and reproductive health. Cultural taboos and religious beliefs have a great impact on adolescents’ sexual behaviour. Most adolescents would not access abortions services because they regard it as killing an innocent baby. Efforts should be strengthened to make contraceptives and family life education available and accessible to the adolescents. / Health Studies / Thesis (M.A. (Health Studies))