Introdução: O uso de métodos anticonceptivos modernos pela maior parte das mulheres brasileiras não diminuiu, conforme esperado, assim como a ocorrência de gestações não desejadas, abortamentos e, consequentemente, mortes maternas, o que revela uso com perfil irregular e descontínuo. No Brasil, há pouca informação sobre os padrões e os determinantes da ocorrência dessas descontinuidades contraceptivas. Devido às inconsistências no uso de métodos serem relativamente comuns, é necessário mensurar o quanto as mulheres interrompem seu uso a despeito de não desejarem engravidar e/ou os alternam inúmeras vezes, nem sempre com opção por um método mais eficaz. Objetivo: Analisar os padrões e os determinantes das descontinuidades contraceptivas no uso da pílula oral, do hormonal injetável e do preservativo masculino. Método: Estudo longitudinal retrospectivo, conduzido com amostra probabilística de 1.551 mulheres de 18 a 49 anos de idade, usuárias de 57 Unidades Básicas de Saúde da cidade de São Paulo/SP (2015) e Aracaju/SE (2016). Os dados foram coletados por entrevista face a face usando o calendário contraceptivo. No Stata 14.2, as análises das taxas de descontinuidade contraceptiva no período de doze meses foram realizadas pelo método de Kaplan-Meier e dos fatores associados por meio dos Modelos de Riscos Proporcionais de Cox, ambos para descontinuidade total, abandono, troca para método menos eficaz e troca para método mais eficaz. Resultados: A taxa de descontinuidade total no uso de métodos foi 41,9% aos doze meses, sendo maior entre usuárias do preservativo masculino (48,1%), seguida de hormonal injetável (39,0%) e pílula oral (38,6%). Entre as usuárias de pílula oral, a taxa de abandono foi a maior; entre as usuárias do hormonal injetável, foi a troca para um método menos eficaz; e, entre as usuárias do preservativo masculino, foi a troca para um método mais eficaz. Os aspectos associados às descontinuidades variam segundo o tipo de método. A descontinuidade no uso da pílula oral foi associada à idade (18-24 anos), vivência de abortamento, incerteza quanto à intenção reprodutiva e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do hormonal injetável foi associada ao maior número de parceiros sexuais, à vivência de abortamento e aos efeitos colaterais/preocupação com a saúde. A descontinuidade no uso do preservativo masculino foi associada à idade (25-34 e 35-49 anos), à união conjugal, ao menor poder aquisitivo (classe econômica D/E) e ao maior número de filhos vivos. Conclusões: Foram observadas altas taxas de descontinuidades no uso de métodos contraceptivos, que variaram conforme o tipo de método. Chama a atenção o papel dos efeitos colaterais na determinação da ocorrência de descontinuidade no uso dos métodos hormonais. Por sua vez, a troca por método mais eficaz foi pouco frequente, com exceção das usuárias de preservativo masculino. Sugere-se ampliar o acesso aos métodos contraceptivos mais eficazes e de longa duração e melhorar a assistência em contracepção nos serviços do Sistema Único de Saúde, de forma a contemplar as necessidades de saúde das mulheres e seus direitos sexuais e reprodutivos. / Introduction: Use of modern contraceptive methods by the majority of Brazilian women did not reduce the occurrence of unintended pregnancies, abortions or maternal deaths as expected, which means that it might be an irregular and discontinuous use. In Brazil, there is a little information on the patterns and determinants of the occurrence of these contraceptive discontinuations. Because inconsistencies in the use of methods are relatively common, it is necessary to measure how much women discontinue their use despite they are willing to get pregnant and/or switching them countless times, not always with the option of a more efficient method. Objective: Our purpose is to investigate patterns and determinants of contraceptive discontinuations in the use of oral pill, hormonal injection and condom. Method: We conducted a retrospective longitudinal study with probabilistic sample of 1,551 women among 18-49 year old who are primary users of 57 health care facilities, both in Sao Paulo (2015) city and Aracaju city (2016). Data were collected by face-to-face interview in line with contraceptive calendar. In Stata 14.2 analyzes of 12-month contraceptive discontinuation rates were performed using the Kaplan-Meier Survival Estimates method and associated factors using the Cox Proportional Hazards Models, both for total discontinuation, abandonment, and switching to a less efficient method and switching to more efficient method. Results: The discontinuation rate in the use of methods was 41.9% at 12 months, being higher among male condom users (48.1%), followed by hormonal injection (39.0%) and oral pill (38.6%). Among oral pill users, the abandon rate was the highest; among users of hormonal injections, was the switching to a less efficient method; and among male condom users, it was the switching to a more efficient method. The aspects associated to the discontinuations varied according to the type of method. Discontinuation of oral pill users was associated with age (18-24 years old), experience of abortion, uncertainty about reproductive intention and side effects/health concern. Discontinuation in the use of hormonal injections was associated with a greater number of sexual partners, the experience of abortion, and the side effects/health concern. Discontinuation of condom users was associated with age (25-34 and 35-49 years old), marital union, lower income and the highest number of live children. Conclusion: High discontinuation rates were observed in the use of contraceptive methods, which varied according to the type of method. The role of side effects/health concern in determining the occurrence of discontinuation in the use of hormonal methods is noteworthy. On the other hand, switching to more efficient method was infrequent, except for the male condoms users. It is suggested to amplify access to the more effective methods as well as long active also improving care in contraception in the all health care facilities services, in order to take into account both women health needs and their sexual and reproductive rights.

En oncologie, les avancées diagnostiques et thérapeutiques ont permis une amélioration significative des taux de survie au prix d’une altération de la santé reproductive des patients due à la gonadotoxicité des traitements. L’attention accordée à la qualité de vie durant et après le cancer est devenue un enjeu majeur de la prise en charge et inclue particulièrement les problématiques liées aux troubles de la sexualité et de la fertilité notamment chez les jeunes femmes. Des stratégies de préservation de la santé reproductive avant initiation des traitements doivent désormais faire partie intégrante de la prise en charge multidisciplinaire du cancer de la femme.L’évaluation épidémiologique et clinique de ces stratégies est indispensable pour améliorer l’offre de soins. Pourtant, le recours à ces stratégies n’avait pas encore été évalué aux Antilles Françaises.Ce projet de thèse, s’appuyant sur quatre études, a tenté de répondre à cette problématique en réalisant un état des lieux des besoins et du recours en préservation de la santé reproductive féminine en contexte de cancer aux Antilles Françaises (Martinique, Guadeloupe). Les différentes parties de ce travail ont été valorisées par des publications scientifiques présentées dans ce manuscrit.Une première étude s’est intéressée aux parcours de soins et réseaux de préservation de la santé reproductive dans le monde. Cette étude a permis de définir le paysage international des modèles organisationnels et la chaîne de coordination de la préservation de la santé reproductive dans le monde pour les patientes atteintes d’un cancer. Elle apporte des arguments afin de réduire les disparités dans l’accès aux soins des jeunes femmes survivant à un cancer dans le monde. Une seconde étude s’est intéressée à explorer l’épidémiologie des cancers de la femme et a permis de proposer une estimation de la population concernée par une préservation de la fertilité aux Antilles Françaises.La troisième étude a permis de réaliser un bilan des pratiques de préservation de la santé reproductive aux Antilles Françaises par l’analyse de l’expérience du CECOS-Caraïbe en matière de préservation de la fertilité féminine puis par la réalisation d’une enquête de pratique menée auprès des médecins impliqués dans la prise en charge oncologique des femmes jeunes aux Antilles Françaises.Enfin, le dernier volet a exploré la prise en charge des cancers associés à la grossesse en Martinique. Cette étude a mis en évidence le véritable challenge thérapeutique que représentent ces cancers rares en contexte insulaire, nécessitant un travail collaboratif régional et interrégional. L’analyse de nos résultats a permis de montrer que l’organisation des soins en préservation de la santé reproductive aux Antilles Françaises reste à structurer et à améliorer sur plusieurs points : l’accès aux soins, l’information des patientes, l’identification de référents en oncofertilité, la formation des professionnels, l’interaction entre les centres d’assistance médicale à la procréation et les services d’oncologie. Pour répondre à ces besoins, des solutions innovantes sont possibles afin de mettre en réseau les différents acteurs. Le projet de Réseau Intercaribbéen Cancer et Santé Reproductive est un projet d’e-santé visant à structurer le parcours de soins des patientes jeunes atteintes de cancer et résidant en Martinique et en Guadeloupe, en construisant un parcours de coopération interrégionale pouvant faire face aux contraintes territoriales. Il s’agit également de porter des projets de recherche sur la thématique de la préservation de la santé reproductive dans nos régions dans le but d’améliorer la qualité de vie des jeunes survivantes résidant aux Antilles Françaises. / In oncology, diagnostic and therapeutic advances have allowed a significant improvement in survival rates at the cost of an alteration of the reproductive health of patients due to the gonadotoxicity of the treatments. The attention given to the quality of life during and after cancer has become a major issue of care and particularly includes issues related to sexual and fertility disorders, especially among young women. Strategies for preserving reproductive health before treatment initiation must now be an integral part of the multidisciplinary management of women's cancer. The epidemiological and clinical evaluation of these strategies is essential to improve the supply of care. However, the use of these strategies had not yet been evaluated in the French West Indies.This thesis project, based on four studies, tried to resolve this issue by realizing an inventory of recourse and needs in the preservation of female reproductive health in a context of cancer in the French West Indies (Martinique, Guadeloupe). The different parts of this work have been promoted through scientific publications presented in this manuscript.A first study looked at care pathways and networks for the preservation of reproductive health in the world. This study has defined the international landscape of organizational models and the chain of coordination for the preservation of reproductive health around the world for cancer patients. It brings arguments to reduce disparities in access to care for young women survivors of cancer around the world. A second study focused on exploring the epidemiology of women's cancers and proposed an estimate of the population concerned by fertility preservation in the French West Indies. The third study is dedicated to a review of the practices of preservation of reproductive health in the French West Indies by highlighting the experience of CECOS-Caraïbe in the preservation of female fertility and by the realization a practice survey conducted among doctors involved in the oncological management of young women in the French West Indies. Finally, the last part explored the management of cancers associated with pregnancy in the French West Indies. This study has highlighted the real therapeutic challenge represented by these rare cancers, requiring regional and interregional collaborative work.The analysis of our results made it possible to show that the organization of care in the preservation of fertility in the French West Indies remains to be structured and improved on several points: access to care, information of the patients, the identification of oncofertility referrals, training of professionals, interaction between the centers of medical assistance to procreation and oncology services.To meet these needs, innovative solutions are possible in order to network the different actors. The project Intercaribbean Network Cancer and Reproductive Health is an e-health project aimed at structuring the path of care of young cancer patients residing in Martinique and Guadeloupe, to build an inter-regional cooperation course that can cope with the constraints territorial. It also involves carrying out research projects on the theme of the preservation of reproductive health in our regions with the aim of improving the quality of life of young survivors living in the French West Indies.

Millions of dollars are spent each year on preventing sexually transmitted diseases (STDs), yet the rates of chlamydia trachomatis (chlamydia) and neisseria gonorrhoeae (gonorrhea) infection continue to be high. Health literacy and its impact have been recognized in diabetes maintenance, control of hypertension, medical adherence, and reproductive health outcomes, yet no research has been conducted regarding the relationship between health literacy and chlamydia and gonorrhea prevalence. This study examined the relationship between health literacy scores and chlamydia and gonorrhea prevalence health literacy scores and reproductive health/STD knowledge, and reproductive health/STD knowledge and chlamydia and gonorrhea prevalence. Participants included 114 women over 18 years of age, who attended community health clinics in the northeastern United States. Health literacy was measured using the Rapid Estimate of Adult Literacy in Medicine instrument, and reproductive health/STD knowledge was assessed using a self-administered questionnaire. Data analysis revealed an inverse correlation between lower health literacy scores and an increase in gonorrhea and combined chlamydia/gonorrhea prevalence. Findings also revealed a positive correlation between health literacy scores and reproductive health/STD knowledge scores. The results of this study suggest that service providers should consider the use of health literacy level with targeted reproductive health and STD messages as a tool to empower clients, decrease the prevalence of chlamydia and gonorrhea, and increase positive reproductive health outcomes.

Mental illness affects more women than men in the United States. Poor mental health in reproductive-age women has negative implications on population health. The purpose of this quantitative, correlational study was to examine the relationship between household structure and frequency of mental distress, with consideration of the mediation social-emotional support provides for reproductive-age women. The social ecological model was the theoretical framework for this research, in which frequency of mental distress related to the individual-level of the human-environment interaction construct. Household structure and social-emotional support were examined at the relationship-level. Pearson's correlation coefficient and linear regression were used to conduct a cross-sectional analysis of the 2010 Behavioral Risk Factor Surveillance System data set with a total sample size of 65,269 women, 18-44 years old. The confounding variables, health care access, race, income, marital status, number of children in the household, and pregnancy status, were included in the analysis. Although social-emotional support significantly influenced both household structure and frequency of mental distress, significance was not found between household structure and frequency of mental distress indicating that mediation does not exist. This study provides researchers and practitioners information about household structure that should be considered when designing innovative, nonprofessional support programs at the community-level. Positive social change implications include an understanding of the relationship between complex variables associated with social-emotional support, which could improve community support programs focused on mental health wellness of reproductive-age women.

In the United States, concerns about adolescent childbearing and its perceived corollaries – negative health outcomes for mother and child, the disintegration of the nuclear family, and “over-dependence” on public resources – began to circulate widely in policy spheres and popular media in the 1970’s, resulting in a proliferation of policies, programs, and services designed to address its prevention. Although national birth rates among adolescents are currently at their lowest since peaking in the early 1990’s, this decline masks persistent and significant disparities between groups of young people by race, ethnicity, geography, and poverty level. The concomitant existence of social and economic inequities that contribute to these differences is particularly striking in New York City; an urban center of vast extremes in health, wealth, and opportunity, but which boasts extensive reproductive health services for young people, including confidential care and availability of free or low-cost contraception. Within this setting, the promotion of hormonal and long-acting reversible contraceptive methods, specifically aimed at young women deemed at high risk of pregnancy and with less access to health care, has emerged as a key primary prevention strategy to reduce both overall adolescent pregnancy rates and disparities between adolescent groups. Using ethnographic methods, this research examined the promulgation and interpretation of this strategy by reproductive health leaders and healthcare workers as well as contextualized these perspectives with the reproductive decisions and fertility desires of female youth for whom this strategy is intended. As a result, this study elucidates broader political and socio-cultural contexts in which young women negotiate intimate relationships and contraceptive use. Recommendations are subsequently offered for clinical practices attuned to female youths’ lived experiences, educational programs for healthcare workers, and reproductive health policies reflective of the broader factors that influence contraceptive behaviors.

Sexual and reproductive health care have become key priorities both within developing and developed nations. Young people have been identified as particularly vulnerable to negative health outcomes. South Africa is one such example of a country that presently faces significant challenges in addressing the unmet sexual and reproductive health needs of young people. With the enormous burden of reproductive health problems and the accelerating HIV epidemic, the provision of sexual and reproductive health services remains a challenge. Though various studies highlight the importance of comprehensive services targeted at youth, there is a lack of adequate research in evaluating the extent to which health services are addressing the health needs of clients. This study aimed to address this gap by examining a health care facility for students at one of the largest tertiary institutions in KwaZulu-Natal. The core objective was to determine the extent to which the health services are responding to the sexual and reproductive needs of young people by, exploring the experiences and perspectives of service providers and young men and women in relation to comprehensive, youth-friendly sexual and reproductive health care. This was assessed using a revised version of the Bruce-Jain quality of care framework. Information for this study was obtained using quantitative and qualitative data collection methods including: an inventory of the facility and services, in-depth interviews with staff and exit interviews with 200 clients aged 18 to 24 years. The findings of the study reveal that logistical constraints hindered effective implementation of comprehensive, youth-friendly services by providers. Providers missed opportunities to provide clients with much needed information and services due to staff shortage, client overload, lack of infrastructure, and poor continuity mechanisms. HIV, STIs and unwanted pregnancies were some of the most important health issues among young people visiting the health facility. Very few young men utilised the services. Some of the key findings were that clients continue to experience barriers in interpersonal relations while many expressed the need for more information from providers. In addition, many young women still have an unmet need for contraception. Policy makers need to incorporate the needs of young clients within sexual and reproductive health initiatives. Ideally young people should be involved in the design and implementation process of comprehensive, youth-friendly health initiatives. This would form a platform for addressing the barriers that hinder health service provision. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2011.

Background: War disproportionately affects women and children, and gender based violence (GBV) has become an increasingly common means of fighting wars and targeting civilians. Such is the case in the Democratic Republic of Congo (DRC), particularly in the eastern provinces, where among the multitude of human rights violations, sexual violence and abuses against women and girls are committed on a large scale. Documented efforts addressing GBV in refugee communities have mainly focused on medical, programmatic, and legal responses; few studies explore the prevalence of GBV among conflict-affected populations. Objective: To determine the prevalence and correlates of outsider violence during and after conflict, and lifetime and past year intimate partner violence (IPV). To determine differences in the proportions of violence victimizations, including the differences in the proportions of outsider violence during and after conflict, and the differences in the proportions of lifetime and past year IPV. To describe patterns of reporting and healthcare seeking related to violence victimization. Methods: Cross sectional data were obtained from a sample of 810 women of reproductive age (WRA) living in two Rwandese refugee camps. GBV was defined as physical violence, sexual violence, or controlling behavior that is committed by intimate partners (IPV) or persons outside the family (outsider violence). Univariate analysis was used to describe the study population as a whole. The chi-square test for independence was used to measure significant differences between women who had identified experiencing GBV and those who did not. A z-test was conducted to explore differences in the proportions of outsider violence during and after conflict, and lifetime and past year IPV. Bivariate and multivariate logistic regression analyses were conducted to assess the unadjusted and adjusted associations between GBV and select variables of interest during and after conflict. Statistical analyses were conducted using SPSS version 14.0 Results: 434 WRA experienced GBV; of which 399 reported experiencing outsider violence before and after conflict, and 130 reported experiencing IPV. The logistical model indicated that there was a consistently significant association between a period of one to five years spent in a refugee camp and outsider violence during conflict (Adj.OR= 0.16; 95%CI:0.10-0.27; P <0.0001), lifetime IPV (Adj.OR=0.17;95%CI:0.10-0.32, p<0.0001), and IPV in the last year (Adj.OR= 0.15;95%CI:0.08-0.28, p<0.0001). Discussion: The results of this study illustrate the importance of assessing the impact of conflict on GBV among refugee and displaced populations. The high prevalence of GBV among this study population, with a prevalence of 53.3% for all forms of violence, is evidence of the great burden GBV poses on this population. Ongoing violence generated by conflict is a major public health concern that urgently requires effective interventions. For example, legal, health, and psycho-social services should be well integrated to adequately screen and address the needs of violence survivors.

The reported percentage of births attributable to school going learners has highlighted the concern for adolescents engaging in early and unsafe sexual practices. A review of literature suggests that early sexual initiation and the likelihood of experiencing teenage pregnancy can impede on adolescents' ability to acquire skills, attain high levels of education, and access socioeconomic opportunities. Relatively less attention has been paid to the reproductive patterns and sexual behaviour of adolescents within informal settlements. This research, conducted in Siyanda informal settlement on the outskirts of KwaMashu Township, is designed to explore the sexual patterns and reproductive behaviour of the adolescents there. The study examines differences in sexual behaviour and childbearing experiences among teen mothers, currently pregnant teens; and those that have never experienced pregnancy. The findings suggest that the majority of adolescents residing in informal settlements experiment with and engage in sexual intercourse at ages much earlier than 19. Most teenagers experienced their first sexual intercourse by the second year of high school education. Teen mothers reported higher incidence of multiple sexual partners. Across all adolescents interviewed, the preferred sexual partners were much older males because of level of maturity, financial status; and the ability to negotiate use of contraceptives. Part of the cause of high incidents of teenage pregnancy within this environment was the lack of consistent usage of contraceptives. Many adolescents perceived usage of contraceptives to be impractical prior to conception of first birth. The experience of childbearing was found to have detrimental implications on these young females‟ educational attainment. Many of these adolescent failed to resume school to complete their education due to the lack of emotional and financial support from their partners and family members. Many adolescents highlighted their discontent with the lack of youth integration with the lack of youth integration in community based programmes. Furthermore, communication barriers in nearby health facilities as well as transport restricted their accessibility to obtain counselling with regards to their sexual activities and reproductive patterns. Thus, it is recommended that service delivery should be improved, including providing more health facilities especially the range of methods through which health officials such as nurses, social workers and counsellors which can be made easily accessible to these adolescents on a regular basis. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2012.

Thesis (M.A.) - Carleton University, 2006. / Includes bibliographical references (p. 113-119). Also available in electronic format on the Internet.

Thesis (M.A. (Population and Reproductive Health Research))--Mahidol University, 2008.