Ce projet aborde la dimension institutionnelle du choix en contraception et questionne la présence et la prévalence, en Haïti, de deux contraceptifs hormonaux longue durée réversibles (LARC) : les injections de Depo-Provera et les implants sous-cutanés. L’approche théorique adoptée est celle de l’anthropologie critique de l’humanitaire et fait usage du concept de dispositif mis de l'avant par Michel Foucault (1975-76) afin d’analyser les différents éléments qui s’articulent au sein du dispositif de santé mondiale tel qu’il se déploie en Haïti. Une analyse de la documentation disponible a permis d’identifier trois paradigmes explicatifs pour les contraceptifs LARC en Haïti : les discours biomédicaux, la structure administrative et le modèle de financement du dispositif de contraception mondiale. L’analyse des discours biomédicaux permet d’entrevoir les différents consensus entourant l’usage des contraceptifs LARC dans les pays en développement, tout en révélant l’impact de l’OMS en tant qu’instance normative dans le contexte des différentes controverses entourant les effets secondaires associés aux technologies contraceptives à progestérone et à longue durée. La structure administrative qui encadre la livraison des contraceptifs aux femmes vivant en Haïti permet de comprendre que les contraceptifs LARC vont de pair avec une approche démédicalisée de la contraception. Enfin le modèle de financement des programmes permet de saisir l’impact des dons en contraceptifs sur l’approvisionnement des programmes de contraception en Haïti, ainsi que la prédominance des organisations philanthropes sur l’orientation biomédicale des programmes de santé mondiale. En discussion le mémoire présente des réflexions anthropologiques critiques et questionne l'adéquation des contraceptifs LARC en Haïti, en raison des impacts de ces médicaments sur la santé, des préoccupations des Haïtiens et de la nécessité de remettre en cause le modèle biomédical en planification familiale. / This project addresses the institutional dimension of contraceptive choice and questions the presence and prevalence in Haiti of two long-acting reversible hormonal contraceptives (LARCs): Depo-Provera injections and subcutaneous implants. The theoretical approach adopted is that of critical humanitarian anthropology and makes use of the concept of "dispositif" in French (translated in "apparatus" by Dreyfus Rabinow in 1984) put forward by Michel Foucault (1975-76) in order to analyze the different elements that are articulated within the Global health system as it unfolds in Haiti. An analysis of the available literature identified three explanatory paradigms for LARC contraceptives in Haiti : biomedical discourse, administrative structure and funding model of the global contraceptive system. The analysis of biomedical discourse provides insight into the different consensuses surrounding the use of LARC contraceptives in developing countries, while revealing the impact of WHO as a normative body in the context of the various controversies surrounding side effects associated with progesterone and long-term contraceptive technologies. The administrative structure that governs the delivery of contraceptives to women living in Haiti makes it possible to understand that LARC contraceptives go hand in hand with a demedicalized approach to contraception. Finally, the program funding model captures the impact of contraceptive donations on the supply of contraceptive programs in Haiti, as well as the predominance of philanthropic organizations on the biomedical orientation of global health programs. In discussion, the paper presents critical anthropological reflections and questions the adequacy of LARC contraceptives in Haiti because of the health impacts of these drugs, the concerns of Haitians and the need to challenge the biomedical model in family planning.

This master thesis focuses on the knowledge of reproductive health among middle schoolers in the targeted middle schools in the Czech Republic. In the theoretical part of my work, I define the term of reproduction health, describe physiology of female and male genitals, disorders in reproductive health, and types of methods -natural invasive- offered by anticonception. Another part of my thesis concerns on reproductive health related to a prostitution, and a sexual abuse, and pregnancy impact on teenage girls' bodies during pubescence. I track the representation of teaching reproductive health in middle schools through RSVP and its main goals in certain areas and key competencies. The goal of my thesis was to map out the knowledge of reproductive health among the students who have been taught this knowledge through a class. As a research methodology, I used a survey that was distributed among middle schoolers in the sixth to eight grades. The results of my survey show that the eighth graders have the most amount of knowledge about reproductive health, but somehow still lower than one might expect. For these reasons, my study intends to deepen the knowledge of reproductive health among middle school students through different projects that will expand students' practical and theoretical knowledge of...

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Abstract Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of women of reproductive age, affecting 5–18% of them. Menstrual irregularities, hyperandrogenemia and obesity are key features in PCOS and they are suggested to be the most important metabolic risks linked to PCOS, but their respective roles are still under debate. Anti-Müllerian hormone (AMH) is involved in sexual differentiation and follicle growth and its level is increased in women with PCOS. The aims of this project were to clarify the significance of menstrual irregularities, hyperandrogenemia and serum levels of AMH in adolescence as predictive factors of the syndrome and to investigate the respective roles of obesity and hyperandrogenism as metabolic risk factors in women with PCOS from adolescence to late adulthood. The study populations were the Northern Finland Birth Cohort 1986 (N=3373 women) and a Nordic population including 1553 women with PCOS and 448 controls. At the age of 16 years, women with menstrual irregularities were more hyperandrogenic compared with women with normal menstrual cycles. Serum AMH levels correlated positively with those of testosterone at this age. They were higher in adolescents with menstrual irregularities compared with those with regular cycles and in women with hirsutism or PCOS at the age of 26 years. However, AMH was not a good marker of metabolic abnormalities in adolescence or a reliable tool to predict PCOS in later life. Androgen levels were higher in women with PCOS throughout life compared with controls. The parameters that best predicted PCOS at all ages were the free androgen index, and androstenedione. Women with PCOS exhibited increased abdominal obesity, altered insulin metabolism, worse lipid profiles and higher blood pressure from early adulthood until menopause compared with controls. The highest prevalence of metabolic syndrome was detected in obese and hyperandrogenic women with PCOS. In conclusion, irregular menstrual cycles, identified by a simple question at adolescence, represent a good marker of hyperandrogenemia, later metabolic risks and development of PCOS. Due to the persistence of hyperandrogenism and metabolic alterations, the treatment of PCOS should be focused on prevention and treatment of these problems as early as in adolescence in order to decrease future morbidity. / Tiivistelmä Monirakkulainen munasarjaoireyhtymä (polycystic ovary syndrome, PCOS) on lisääntymisikäisten naisten tavallisin (5-18%) hormonaalinen häiriö. Kuukautishäiriöt, mieshormoniylimäärä eli hyperandrogenismi ja lihavuus kuuluvat oireyhtymään oleellisesti ja niiden ajatellaan olevan tärkeimmät PCOS:aan liittyvät metaboliset riskitekijät, vaikkakin niiden tarkat roolit ovat epäselvät. Anti-Müllerian hormoni (AMH) vaikuttaa sukupuolen kehitykseen sikiöaikana sekä munarakkuloiden kypsymiseen hedelmällisessä iässä ja sen pitoisuus on suurentunut PCOS-naisilla. Tämän väitöskirjan tavoitteena oli selvittää kuukautishäiriöiden, hyperandrogenismin ja AMH-pitoisuuden ennustearvoa PCOS-oireyhtymälle, sekä arvioida lihavuuden ja hyperandrogenismin vaikutusta metabolisiin riskitekijöihin PCOS-naisilla läpi elämän. Tutkimusaineistoina olivat Pohjois-Suomen syntymäkohortti 1986 (N=3373 naista) sekä pohjoismaalainen yhteistyöaineisto, jossa oli 1553 PCOS-naista ja 448 kontrollia. 16-vuotiaiden kuukautishäiriöistä kärsivien naisten mieshormonipitoisuuksien todettiin olevan korkeammat kuin naisilla, joilla kuukautiskierto oli säännöllinen. AMH-tasot korreloituivat positiivisesti testosteronin kanssa 16-vuotiaana, ja pitoisuus oli koholla naisilla, joilla todettiin kuukautishäiriö. AMH-tasot 16-vuotiaana olivat myös korkeampia naisilla, joilla oli 26-vuotiaana PCOS tai hirsutismi. Kuitenkaan AMH-pitoisuus 16-vuotiaana ei korreloinut metabolisten riskitekijöiden kanssa eikä se ollut luotettava parametri ennustamaan PCOS:n kehittymistä. Mieshormonitasot olivat korkeammat PCOS-naisilla läpi elämän verrattuna kontrolleihin. Vapaan mieshormonin indeksit ja androstendioni olivat parhaat parametrit erottamaan PCOS-naiset kontrolleista. PCOS-naisilla todettiin olevan enemmän vyötärölihavuutta, huonompi veren rasvaprofiili ja korkeampi verenpaine varhaisaikuisuudesta menopaussiin saakka. Lihavilla hyperandrogeenisilla naisilla todettiin suurin metabolisen oireyhtymän esiintyvyys. Yksinkertaisella kysymyksellä selvitetyt kuukautishäiriöt nuoruusiässä todettiin olevan yhteydessä hyperandrogenismiin sekä myöhempiin metabolisiin riskeihin ja PCOS:n kehittymiseen. Jotta pystyttäisiin vähentämään myöhempää sairastavuutta ja kuolleisuutta PCOS-naisilla, oireyhtymän hoidon tulisi keskittyä ennaltaehkäisemään ja hoitamaan lihavuutta, hyperandrogenismia ja metabolisia riskejä jo varhaisaikuisuudessa.

Magister Public Health - MPH / Teenage pregnancy is one of the major public health problems facing teenage girls in Zambia (Webb, 2000; Warenius, 2008). Teenage girls access to and utilization of adolescent reproductive health (ARH) services is important for the prevention of teenage pregnancies and sexually transmitted infections (STIs) amongst teenagers.High incidence of teenage pregnancies has been noted in the district despite availability of ARH services. Teenage pregnancy is a major contributing factor to the high school drop-out rate amongst the girls and is one of the challenges faced by non-governmental organizations (NGOs) that support girl child education, such as the campaign for female education (CAMFED) as well as for government agencies such as the Ministry of Education. The high incidence of teenage pregnancies could be an indication of poor access to and utilization of ARH services and therefore an assessment of the accessibility and utilization of the ARH services was done to explore the reasons for this.This research aimed to explore the factors affecting teenage girls access to and utilization of ARH services in the Mpika district, Zambia. The research was a qualitative, descriptive and exploratory study using individual interviews with ten in-school teenage girls, four key informants rendering ARH services and a focus group discussion (FGD) with ten pregnant teenage girls. By exploring these particpants perceptions and experiences, appropriate interventions to improve accessibility to and utilization of ARH services could be designed that would be appropriate for the local context in order for them to be effective. Thematic analysis with categorizing and coding methods was used to analyze the data. The study used the theory of planned behaviour (TPB) which stipulates that an individuals attitude,subjective norms and perceived behavioural control influence behaviour as a framework to explain the findings of the results of the study. The findings of the study indicated that physical, psychological and social barriers hindered adolescents from accessing and utilizing ARH services. The findings also suggested that high levels of knowledge about RH services do not necessarily translate into accessibility and utilization of ARH services. Accessibility to and utilization of ARH services by adolescents can also be determined by an individual attitude, subjective norms, and perceived behavioural control as illustrated by the TPB. Adolescents need to feel comfortable using ARH services. Therefore the three variables of TPB should be taken into consideration when designing comprehensive ARH programmes in order to accommodate the unique reproductive health needs of the adolescents. There is need to encourage participation in and involvement of adolescents in planning and implementation of ARH programmes. The participants also made recommendations which included strengthening information and education on ARH, strengthening adolescent-friendly services, improving staffing levels and promotion of school health services. / South Africa

Background: Involuntary childlessness and infertility affect a large group of people and WHO calls it a global public health issue. Donated gametes can be used when a pregnancy is not achieved. Embryo donation involves the full genetic material of the donating couple and embryo donation for reproductive purposes are often associated with many emotional, ethical, legal and psychosocial aspects. Aim: The aim of the study was to examine views on embryo donation for reproductive purposes among couples with experience of cryopreserved embryos. Methods: A literature review was conducted in order to answer the aim. Two databases (PubMed and Web of Science) were used to identify relevant qualitative literature. A smaller search on Google Scholar was also included. Inclusion and exclusion criteria were pre-determined in order to limit which studies to include. Results: A total of 20 studies were included in the results. The results show that there are different views towards the status of the human embryo, views towards the genetic link, information sharing and screening, views towards the selection of recipients, views towards the contact and relationship between donors, recipients and offspring, and views towards the decision-making and whether to donate surplus embryos or not. Conclusion: The multiple understandings of the status of the human embryo emphasizes the complex nature of human embryos and may explain couples’ views on embryo donation for reproductive purposes. It has also the potential to explain what couples decide to do with their surplus embryos. The interests of the receiving couple, the donors, the future child, and the society should continuously be assessed and balanced when society regulates ART and embryo donation. / Bakgrund: Ofrivillig barnlöshet och infertilitet påverkar många människor och WHO kallar det ett globalt folkhälsoproblem. Donerade könsceller kan användas när en graviditet inte kan uppnås. Vid embryodonation innebär det att det donerande paret har full genetisk koppling till embryot och embryodonation för reproduktiva syften associeras ofta med många emotionella, etiska, rättsliga och psykosociala aspekter. Syfte: Syftet med studien var att undersöka synen på embryodonation för reproduktiva ändamål hos par med erfarenhet av frysförvarade embryon. Metod: En allmän litteraturstudie genomfördes för att besvara syftet. Två databaser (PubMed och Web of Science) användes för att identifiera relevanta kvalitativa studier. En mindre sökning utfördes även i Google Scholar. Inklusions- och exklusionskriterier bestämdes i förväg för att begränsa vilka studier som skulle ingå. Resultat: Totalt inkluderades 20 artiklar i resultatet. Resultatet visar att det finns olika uppfattningar om det mänskliga embryots status, om den genetiska kopplingen, informationsutbyte och screening, om synen på kontakt och relationen mellan donatorer, mottagare och avkomma samt synen på beslutsfattandet och om överskott av embryon ska doneras eller inte. Slutsats: De många uppfattningarna om det mänskliga embryots status betonar den komplexa karaktären hos det mänskliga embryot och kan förklara parens syn på embryodonation för reproduktiva ändamål. Det har också potential att förklara vad par väljer att göra med sina överskott av embryon. Det mottagande parets, donatorernas, det framtida barnets och samhällets intressen bör kontinuerligt bedömas och balanseras när samhället reglerar ART och embryodonation.

Bakgrund: Alla individer har rätt till information, hälsovård och stöd för att uppnå god potential gällande sexuell och reproduktiv hälsa och rättigheter (SRHR). I Sverige finns goda förutsättningar för sexualundervisning av hög kvalitet i skolan. Trots detta finns kvalitetsbrister i undervisningen och kvinnor saknar kunskap om SRHR. Kondom används mer sällan vid samlag med en ny partner och kvinnor utsätter sig därmed för en ökad risk för oönskade graviditeter och sexuellt överförbara sjukdomar. Syfte: Att undersöka hur unga kvinnor fått kunskap om SRHR, vilken kunskap unga kvinnor saknade från skolans sexualundervisning och vilken kunskap och erfarenheter de hade av sin sexuella och reproduktiva hälsa. Metod: En kvantitativ tvärsnittsstudie med kvalitativa inslag utfördes med egenkonstruerade enkäter som datainsamlingsmetod. Sjuksköterskestudenter mellan 18–30 år besvarade enkäten och resultatet analyserades med deskriptiv statistik. Resultat: Totalt 84 kvinnor besvarade enkäten (86,6%). Kvinnorna hade fått utbildning om SRHR i grundskolan. Sexualundervisningen uppfattades vara bristfällig och ansågs utgå från för snäva perspektiv. Kvinnorna saknade tillräcklig kunskap om reproduktion. Kvinnorna hade kunskap om vilka könssjukdomar som kan leda till minskad fertilitet, trots detta hade många av kvinnorna haft oskyddat samlag med en ny sexuell kontakt. Många kvinnor hade besökt en barnmorska och skattade sin sexuella hälsa som bra eller mycket bra. Slutsats: Skolans sexualundervisning bör vara återkommande under hela skolgången och vara av god kvalitet för att stötta kvinnor att fatta ansvarsfulla och välgrundade beslut gällande SRHR. Det krävs tydliga mål för innehållet i undervisningen för att främja möjligheterna till god sexuell och reproduktiv hälsa. Barnmorskor möter unga kvinnor i sitt arbete och SRHR är barnmorskans kompetensområde, här kan barnmorskan stötta och vägleda kvinnor genom hela livet. / Background: All individuals are entitled to information, healthcare and support to achieve good potential of sexual and reproductive health (SRHR). In Sweden, there are good prerequisites for high quality education. However, there are quality deficiencies in teaching and women lack knowledge of SRHR. Condoms are rarely used when having intercourse with a new partner and women accordingly expose themselves to an increased risk of unwanted pregnancies and sexually transmitted infections. Objective: To investigate how young women acquired knowledge about SRHR, perceived lack of knowledge from sex education, what knowledge they had and what experiences they had of their sexual and reproductive health. Method: The study was performed through a quantitative cross-sectional study with qualitative elements using self-constructed questionnaires as data collection method. Nursing students between 18-30 years completed the questionnaire and the result was analysed with descriptive statistics. Results: A total of 84 women completed the questionnaires (86,6%). The women had been educated about SRHR in elementary school. Sex education was perceived to be inadequate and was explained from a narrow perspective. The women lacked sufficient knowledge of reproduction. The women had knowledge of which sexually transmitted infections that can lead to reduced fertility, in spite of this many women have had unprotected intercourse with a new sexual contact. Many women have visited a midwife and self-estimated their sexual health as good or very good. Conclusion: Education should be recurring throughout schooling and be of good quality to support women in making responsible and informed decisions regarding SRHR. Clear objectives are required for the content of the teaching to promote the opportunities for good sexual and reproductive health. Midwives meet young women in their work and SRHR is the midwife’s area of expertise, where the midwife can support and guide women throughout their lives.

Bakgrund: Många barn kommer i kontakt med pornografiskt material under sin uppväxt. Pornografi är lättillgängligt och kan påverka beteenden, kroppsideal och föreställningar av sexualitet. Det kan problematiseras utifrån hälsa, jämställdhetssynpunkt och Sexuell och Reproduktiv Hälsa och Rättigheter (SRHR). Arbetet med SRHR sker både inom skolan och hälso- och sjukvård. Det finns behov av att prata om pornografi inom det hälsofrämjande arbetet med barn, där skolsköterskan har en viktig roll. Motiv: Tydliga riktlinjer kring hur skolsköterskor bör adressera ämnet saknas. Genom att beskriva skolsköterskors uppfattning kring att prata om pornografi kan en djupare förståelse fås för de behov, utmaningar och möjligheter som finns och därmed kan en förståelse erhållas för hur arbetet kan utvecklas. Syfte: Beskriva skolsköterskors uppfattning av att prata om ämnet pornografi i sitt hälsofrämjande arbete. Metod: Semistrukturerade intervjuer genomfördes med nio skolsköterskor inom grundskolan. Kvalitativ innehållsanalys användes för att analysera den insamlade datan. Resultat: Skolsköterskorna upplevde det viktigt att prata om pornografi med barn. Att våga prata, vara lyhörd, respektfull och inge förtroende lyftes som viktiga egenskaper för att få barnen att känna sig bekväma i samtalen. Skolsköterskorna ville förmedla en medvetenhet kring ämnet, såsom kritiskt förhållningssätt samt förmedla en annan bild av sexualitet. Det fanns svårigheter i när och hur ämnet skulle börja pratas om. Ett behov av ökad kunskap i ämnet och förståelse för vad barnen möter lyftes. Det upplevdes finnas behov att prata om ämnet kontinuerligt, och samverkan med andra kunde utgöra antingen ett hinder eller en tillgång. Konklusion: Att prata om ämnet pornografi med barn är känsligt och komplext men sågs som viktigt utifrån professionen. Ämnet kan bemötas på olika sätt men det behövs mer kunskap, kontinuitet och god samverkan. Utformning av evidensbaserade arbetsmodeller för samtal om pornografi skulle kunna minska osäkerheten bland skolsköterskorna. / Background: Many children encounter pornography during their childhood. Pornography is easily accessible and may affect behaviours, body ideals and ideas in relation to sexuality. This can be problematised from a health, gender equality and SRHR (sexual and reproductive health and rights) perspective. The work with SRHR is carried out within schools and healthcare, where the school nurse plays an important role. Motive: There is an absence of guidelines on how school nurses should address pornography. By describing school nurses’ perceptions about talking about pornography, a deeper understanding about the existent needs, challenges and opportunities can emerge and enable an appreciation on how to improve the work. Aim: To describe school nurses’ perceptions regarding talking about pornography within their health promoting work. Methods: Semi-structured interviews with nine school nurses were conducted. The data was analysed using qualitative content analysis. Result: The school nurses expressed that it was important to talk about pornography with the children. Courage, confidence, being careful and respectful, was described as valuable qualities in making the children feel more comfortable when discussing pornography. The school nurses wanted to convey a critical approach to pornography, and reveal a different view of sexuality. However, determining when and how the subject should be brought up proved difficult. The school nurses expressed a need for increased knowledge and understanding regarding children's experiences online, as well as a need to address the subject regularly. Cooperation with other professionals in the school could either be an obstacle or an asset. Conclusion: Talking about pornography is complex and sensitive, but it was thought of as important within the profession. The subject can be addressed in different ways but an increased knowledge, continuity and cooperation is required. A formation of evidence based working models for talking about pornography could decrease insecurity among school nurses.

Thesis (M. Law. (Development and Management)) --University of Limpopo, 2019 / Like many other countries, South Africa has its own socio-economic challenges. For the past two decades, the country has been experiencing rapid population growth, yet in the same period, there has been a pervasive decline in social and economic stability, and in the end, stagnant human wellbeing. This has been as a result of diminishing access to basic services such as health care, quality housing, quality education and safe clean drinking water. Among other factors, unregulated and rapid population growth contribute to these socio-economic challenges. This study seeks to illustrate that overpopulation undermines and threatens social development, societal stability and survival of humanity. Therefore, the examines the possibility of enacting a legislation or policy that will regulate or limit procreation or the right to give birth. It also reflects on the Chinese experience to obtain some lessons from China’s One-Child Policy. It is submitted that South Africa must draft its own policy or legislation that will regulate population growth with the primary objective of aligning population with available state resources. Keywords: overpopulation, right to reproductive health, socio-economic rights, human wellbeing, social transformation.

The multiple components of Sexual and Reproductive Health and Rights (SRHR), promotes women’s wellbeing and rights to a life free from discrimination and violence. Gender-based violence (GBV) is a matter closely related to SRHR and affects women globally on daily basis. South Africa is estimated to score one of the highest rates of GBV in the world. This thesis aims to gain an understanding of how civil society organisations (CSOs) working with SRHR-related issues, approach South African state institutions with regard to strengthen strategies against GBV. A qualitative content analysis is adopted to analyse the CSO’s documents that frame their advocacy work against GBV and how they approach state institutions in South Africa. The results from the analysed documents are thereby examined through theoretical approaches, mainly targeting CSOs ability to translate universal human rights into local contexts, and contributions to social justice. The analysed documents reveal that the selected CSOs mobilise their advocacy against GBV through different media platforms. Moreover, the CSO’s advocacy is presented through evidence-based research, policy briefs, articles and campaigns. Through their approaches to state institutions, the CSOs demand the state to recognise that inequality and patriarchal structures cause GBV and negatively affect women’s wellbeing. Furthermore, the selected CSOs demand fair distribution of resources that ensures women’s safety in the public sphere. In addition, the CSOs demand implementation of educational programmes with gender perspectives in all aspects of society. Finally, the CSOs demand South African state institutions to include all sectors of society in decision-making processes of strategies against GBV. Thus, state institutions can unsure proper implementation of preventative methods against GBV.