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Syftet med studien var att undersöka om det digitala inlärningsprogrammet Privatliv kan vara ett adekvat stöd för speciallärare i undervisning inom ämnesområdet sexualitet, samtycke och relationer i den anpassade grundskolan. Valet grundar sig i en avsaknad av anpassade läromedel som vänder sig till elever i anpassad grundskola. Undersökningen syftade till att synliggöra vilka normer läromedlet förmedlar, om alla delar i läroplansmålen för år 7–9 finns med, om det förmedlar ett riskperspektiv eller ett friskperspektiv gällande ämnesområdet samt hur läromedlet är anpassat för att möta elevers olika behov och förutsättningar. För att undersöka detta användes en kvalitativ metod med en socialkonstruktivistisk ansats. Inspirerad av den kritiska diskursanalysen har vi genomfört en läromedelsanalys för att komma åt det mer implicita innehållet. Resultat som framkommit visar att Privatliv kan vara ett adekvat stöd i undervisning, men däremot behöver några delar tillföras för att kunna innehålla alla läroplansmål. Några delar från läroplansmålen saknas och vissa delar anser vi kräver lite mer fördjupad kunskap kring. Anpassningar finns men programmet skulle nå fler elever och vara ett fördelaktigare stöd för undervisande speciallärare om innehållet skulle anpassas ytterligare. Privatliv förmedlar i överlag ett friskperspektiv. Läromedlet avviker från heteronormen genom att belysa homosexualitet och bisexualitet och en HBTQ-norm är framträdande. En slutsats i studien visar hur viktigt det är att granska läromedel, men även betydelsen av kompetent personal som ska undervisa eleverna med hjälp av läromedlet.

This research study examines Jewish women’s traditions from the perspective of midwives, in the United States (US), particularly midwives in Florida and New York, based on their work caring for women of childbearing age in the Hasidic Ashkenazi and Sephardic Orthodox communities. The reproductive traditions examined in this research may be practiced differently depending on a woman’s degree of religiosity and the rabbinic authorities in their communities. The primary data I collected in this study are based on ethnographic methods, including participant-observation with midwives, and semi-structured interviews with midwives and rebbetzins. The secondary data draws on my analysis of the professional context for the practice of midwifery in the US, and Talmudic texts and rabbinical rulings related to family planning, reproduction, and sexuality education. This study shows how midwives are central to these traditions and facilitate not only the family planning and childbearing experiences, but also the religious practices that go with reproductive healthcare. This research also demonstrates how midwives who take care of Jewish women negotiate on behalf of their patients with the local rabbis to provide care that is patient-centered and clinically recommended on the one hand but is culturally appropriate on the other hand. My research study builds on and contributes to anthropological scholarship about Jewish women and reproductive healthcare, and considers whether, and how, the reproductive health practices of the Hasidic women are surviving in a changing world.

Contexte et objectifs : Les services de santé sexuelle et reproductive des adolescents (SSRA) ont fait l’objet de peu d’études au Niger. Cette thèse avait pour objectif d’analyser les relations entre les capacités des organisations, la mobilisation et l’utilisation des ressources en SSRA. La thèse propose tout d’abord une description rétrospective des interventions en SSRA et une analyse de l’offre des services de SSRA et du profil des acteurs impliqués dans la conception et la mise en œuvre des interventions en SSRA pour comprendre le contexte de l’étude. Méthodologie : Une revue documentaire narrative et des entrevues individuelles ont été réalisées pour examiner l’historique des interventions en matière de SSRA mises en œuvre au Niger depuis 1975 jusqu’en 2021. De même, cela nous a permis d’identifier les acteurs impliqués et leur rôle dans le processus de mise en œuvre de ces interventions (article 1). Des données secondaires ont été utilisées à travers un modèle Generalized estimating equation (GEE) et une approche comparative entre trois pays : Burkina Faso, Ghana et Niger pour analyser le profil des structures de santé, l’offre du panier de services planification familiale (PF) aux adolescents non mariés et les déterminants de cette offre (article 2). Des données primaires ont été collectées auprès de 250 organisations ayant mis en œuvre des interventions en SSRA sur la période de 2017 à 2021 au Niger. Ces données ont été utilisées pour analyser la relation entre les capacités organisationnelles et la mobilisation des ressources (article 3) en utilisant un modèle de régression logistique multinomiale ordonnée. De même, ces données ont été utilisées pour analyser la relation entre les capacités organisationnelles et l’utilisation effective et efficiente des ressources mobilisées. Un modèle Logit binaire a été estimé pour examiner la relation entre les capacités organisationnelles et l’utilisation effective des ressources mobilisées (article 4). Enfin, un modèle de frontière stochastique et un modèle de Tobit ont été utilisés pour déterminer les scores d’efficience technique et analyser la relation entre les niveaux des capacités des structures de santé et leurs scores d’efficience technique dans l’utilisation des ressources pour offrir les produits et services de SSR aux adolescents (article 5). Résultats : Les résultats de cette thèse font ressortir dans un premier temps un éventail d’interventions en SSRA mises en œuvre et d’acteurs avec des profils variés qui sont impliqués dans le processus d’élaboration et la mise en œuvre de ces interventions au Niger. Les décennies 2000 et 2010 ont constitué les périodes où la plupart des interventions ont été mises en œuvre pour améliorer la SSRA. L’État demeure l’acteur principal, mais il est accompagné techniquement et financièrement par d’autres acteurs. Parmi ces derniers, il y a les bailleurs de fonds constitués par des institutions des Nations unies comme le Fonds des Nations Unies pour la population (UNFPA), l’Organisation mondiale de la santé (OMS) et la Banque Mondiale, des gouvernements des pays amis du Niger, des fondations et des institutions de recherche. L’État reste la deuxième source de financement. Toutefois, bien que beaucoup d’efforts aient été consentis pour améliorer l’accès aux services de SSRA, des adolescents non mariés éprouvent des difficultés d’accès, car beaucoup de structures de santé n’offrent pas ces services à cette population. Au Niger, seuls 29% des structures de santé ont déclaré offrir le panier de services de PF aux adolescents non mariés en 2017 contre 70% et 60% respectivement au Burkina Faso et au Ghana. Plusieurs facteurs expliquent cette offre. Parmi ces derniers, il y a le genre du premier responsable dont les résultats montrent que les structures de santé dirigées par les femmes ont plus de chance d’offrir le panier de services PF aux adolescents non mariés que celles dirigées par un homme. De plus, l’analyse de profil effectuée sur ces structures montre une hétérogénéité. Au Ghana, par exemple, on trouve un profil plus diversifié composé des centres de santé, des hôpitaux et polycliniques et des « Community-based Health Planning and Services » (CHPS) tandis qu’au Burkina Faso et au Niger, ce sont plutôt des structures de santé du premier niveau. Le secteur privé est aussi assez présent alors qu’il ne l’est qu’à une proportion très marginale (moins de 1%) au Burkina Faso et au Niger. Par ailleurs, les résultats indiquent une relation positive entre les niveaux des capacités des organisations et leur niveau de mobilisation des ressources financières. Autrement dit, plus les organisations améliorent leur niveau des capacités, plus leur niveau de mobilisation des ressources financières est important. Toutefois, la relation diffère d’une dimension des capacités organisationnelles par rapport à une autre. Elle est plus importante pour les capacités managériale et opérationnelle et moins prononcée pour les capacités en leadership et adaptative. Il se dégage également une relation positive entre le niveau des capacités organisationnelles et l’utilisation effective des ressources financières mobilisées pour offrir des services de SSR aux adolescents ou pour réaliser des activités en SSRA. Par exemple, lorsqu’une organisation augmente son niveau de capacités organisationnelles augmente d’une unité, sa probabilité d’utiliser effectivement les ressources financières mobilisées augmente de 1,7%. Il apparait aussi que les structures de santé qui offrent les services de santé sexuelle et reproductive aux adolescents ont en moyenne un score d’efficience technique de 58%. Ce score est plus important chez les structures de santé dirigées par les femmes que celles dirigées par les hommes. De même, les structures de santé qui améliorent simultanément le niveau de leurs capacités : managériale, opérationnelle, adaptative et en leadership ont un score d’efficience technique plus important que celles qui ne l’ont pas fait. Toutefois, la relation entre ces capacités diffère d’une dimension à une autre. Contribution : Les résultats de cette thèse améliorent les connaissances sur l’analyse des interventions en SSRA dans les pays en développement. Ils constituent aussi un ensemble de données probantes sur lesquelles les acteurs impliqués dans la problématique de la SSRA peuvent s’appuyer pour mieux concevoir et mettre en œuvre les interventions en SSRA, capables de rendre les services de SSRA disponibles, accessibles et utilisables. / Background and objectives: Adolescent sexual and reproductive health (ASRH) services have been little studied in Niger. The aim of this thesis was to analyze the relationship between organizational capacity and the mobilization and use of ASRH resources. The thesis begins with a retrospective description of ASRH interventions and an analysis of ASRH service provision and the profile of actors involved in the design and implementation of ASRH interventions to understand the context of the study. Methodology: A narrative literature review and individual interviews were conducted to examine the history of ASRH interventions implemented in Niger from 1975 to 2021. This also enabled us to identify the actors involved and their role in the process of implementing these interventions (article 1). Secondary data were used through a generalized estimating equation (GEE) model and a comparative approach between three countries: Burkina Faso, Ghana and Niger to analyze the profile of health facilities, the supply of the family planning (FP) basket of services to unmarried adolescents and the determinants of this supply (article 2). Primary data were collected from 250 organizations that had implemented ASRH interventions between 2017 and 2021 in Niger. These data were used to analyze the relationship between organizational capacity and resource mobilization (article 3) using an ordered multinomial logistic regression model. Similarly, these data were used to analyze the relationship between organizational capacity and the effective and efficient use of mobilized resources. A binary Logit model was estimated to examine the relationship between organizational capabilities and the effective use of mobilized resources (article 4). Finally, a stochastic frontier model and a Tobit model were used to determine technical efficiency scores and to analyze the relationship between health facility capacity levels and their technical efficiency scores in the use of resources to provide SRH products and services to adolescents (article 5). Findings: The results of this thesis first highlight a range of ASRH interventions that have been implemented and actors with varied profiles who are involved in the process of developing and implementing these interventions in Niger. The decades 2000 and 2010 were the periods when most interventions were implemented to improve ASRH. The state remains the main actor, but it is supported technically and financially by other actors. These include donors such as United Nations agencies like the United Nations Population Fund (UNFPA), the World Health Organisation (WHO) and the World Bank, governments of countries friendly to Niger, foundations and research institutions. The State remains the second largest source of funding. However, although a great deal of effort has been made to improve access to ASRH services, unmarried adolescents still have difficulty gaining access, as many health facilities do not offer these services to this population. In Niger, only 29% of health facilities reported offering the FP basket of services to unmarried adolescents in 2017, compared with 70% and 60% respectively in Burkina Faso and Ghana. Several factors explain this offer. One of these is the gender of the primary caregiver, the results of which show that female-headed health facilities are more likely to offer the FP basket of services to unmarried adolescents than those headed by a man. In addition, the profile analysis carried out on these facilities shows heterogeneity. In Ghana, for example, we find a more diversified profile made up of health centres, hospitals and polyclinics, and Community-based Health Planning and Services (CHPS), whereas in Burkina Faso and Niger, it is more likely to be first-level health facilities. The private sector is also well represented, whereas in Burkina Faso and Niger it is very marginal (less than 1%). Furthermore, the results indicate a positive relationship between the capacity levels of the organizations and their level of mobilization of financial resources. In other words, the more organizations improve their level of capacity, the greater their level of mobilization of financial resources. However, the relationship differs from one dimension of organizational capabilities to another. It is stronger for managerial and operational capabilities and less pronounced for leadership and adaptive capabilities. There is also a positive relationship between the level of organizational capacity and the effective use of financial resources mobilized to provide SRH services to adolescents or to carry out ASRH activities. For example, when an organization increases its level of organizational capacity by one unit, its probability of using the financial resources mobilized increases by 1.7%. It also appears that health facilities offering sexual and reproductive health services to adolescents have an average technical efficiency score of 58%. This score is higher for female-run facilities than for male-run facilities. Similarly, health facilities that simultaneously improve their managerial, operational, adaptive and leadership capacities have a higher technical efficiency score than those that do not. However, the relationship between these capabilities differs from one dimension to another. Contribution: The results of this thesis improve knowledge on the analysis of ASRH interventions in developing countries. They also provide a body of evidence on which ASRH stakeholders can draw to better design and implement ASRH interventions, capable of making ASRH services available, accessible and usable.

Deterrents to family planning practices were investigated among Swazi women between 1999- 2001. A total of 171 adolescents, women and men participated in focus group interviews. Information obtained in this way served as a framework for designing structured interview schedules. The views of 205 women were investigated, concerning factors deterring them from using family planning practices by means of conducting face to face studied interviews. Qualitative data were analysed using the NU*DIST and for the quantitative data the SPPS computer programs were used respectively. The results revealed that socio-cultural deterrents to family planning included high cultural value of children determining women's social status, the lack of knowledge about contraceptives, women's dependence on their husbands' decisions concerning reproductive issues and inefficient family planning services. Recommendations included that specific adolescent reproductive health services should be instituted and that the policy on reproductive health for Swaziland be revised. Reproductive health issues should be addressed in the school curriculum. All Swazi men and women, both adolescents and adults, should be educated about contraceptives. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

Deterrents to family planning practices were investigated among Swazi women between 1999- 2001. A total of 171 adolescents, women and men participated in focus group interviews. Information obtained in this way served as a framework for designing structured interview schedules. The views of 205 women were investigated, concerning factors deterring them from using family planning practices by means of conducting face to face studied interviews. Qualitative data were analysed using the NU*DIST and for the quantitative data the SPPS computer programs were used respectively. The results revealed that socio-cultural deterrents to family planning included high cultural value of children determining women's social status, the lack of knowledge about contraceptives, women's dependence on their husbands' decisions concerning reproductive issues and inefficient family planning services. Recommendations included that specific adolescent reproductive health services should be instituted and that the policy on reproductive health for Swaziland be revised. Reproductive health issues should be addressed in the school curriculum. All Swazi men and women, both adolescents and adults, should be educated about contraceptives. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

Unwanted and unintended pregnancies pose major reproductive health challenges to women throughout the world. Despite the availability of modern contraceptives, many women and men fail to use contraceptives effectively. This research focussed on reasons for not using contraceptives effectively in the Northern Tshwane area of the Gauteng Province of the Republic of South Africa (RSA). Structured interviews were conducted with 83 women and 71 men about their contraceptive practices. Age, religion, educational level and residential areas influenced clients' contraceptive practices. These results were categorised for adult males and females as well as for adolescent males and females. Adolescents encountered problems in accessing contraceptive services. Adult females knew most about traditional contraceptives, although men knew about some of these methods, and adolescents used some of them. All respondents could gain additional knowledge about modern contraceptives. The respondents' knowledge about · emergency contraceptives was extremely limited. Although most respondents knew about legalised choice on.termination of pregnancy (CTOP) services in the RSA, they did not know when nor how to access these services. Nurses working in contraceptive health services, revealed during a focus group discussion that a lack of resources (including shortages of malcondoms, contraceptive injections and oral contraceptives) hampered the quality of services that could be rendered. Of particular concern was the nonavailability of Norplant implants and female condoms. Nurses expressed a need for pecific national policy guidelines about supplying contraception to adolescents. Although most nurses knew about emergency contraceptives, they did not promote its use because they assumed that clients would misuse emergency contraceptives.instead of using contraceptives regularly. The nurses indicated that very few facilities offered CTOP services. The nurses regarded women who obtained repeated CTOPs to be misusing these services and suggested that limitations should be placed on the number-of times any woman could obtain such services. The negative attitudes of community members and of colleagues towards persons working in CTOP services caused hardships for them. Recommendations address ways in which contraceptive services could be improved. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

Unwanted and unintended pregnancies pose major reproductive health challenges to women throughout the world. Despite the availability of modern contraceptives, many women and men fail to use contraceptives effectively. This research focussed on reasons for not using contraceptives effectively in the Northern Tshwane area of the Gauteng Province of the Republic of South Africa (RSA). Structured interviews were conducted with 83 women and 71 men about their contraceptive practices. Age, religion, educational level and residential areas influenced clients' contraceptive practices. These results were categorised for adult males and females as well as for adolescent males and females. Adolescents encountered problems in accessing contraceptive services. Adult females knew most about traditional contraceptives, although men knew about some of these methods, and adolescents used some of them. All respondents could gain additional knowledge about modern contraceptives. The respondents' knowledge about · emergency contraceptives was extremely limited. Although most respondents knew about legalised choice on.termination of pregnancy (CTOP) services in the RSA, they did not know when nor how to access these services. Nurses working in contraceptive health services, revealed during a focus group discussion that a lack of resources (including shortages of malcondoms, contraceptive injections and oral contraceptives) hampered the quality of services that could be rendered. Of particular concern was the nonavailability of Norplant implants and female condoms. Nurses expressed a need for pecific national policy guidelines about supplying contraception to adolescents. Although most nurses knew about emergency contraceptives, they did not promote its use because they assumed that clients would misuse emergency contraceptives.instead of using contraceptives regularly. The nurses indicated that very few facilities offered CTOP services. The nurses regarded women who obtained repeated CTOPs to be misusing these services and suggested that limitations should be placed on the number-of times any woman could obtain such services. The negative attitudes of community members and of colleagues towards persons working in CTOP services caused hardships for them. Recommendations address ways in which contraceptive services could be improved. / Health Studies / D. Litt. et Phil. (Advanced Nursing Sciences)

Adolescent pregnancy is a worldwide problem. This study attempted to describe and explore the knowledge of female adolescents in Angola's knowledge with regard to contraception. The research results, obtained from interview schedules, revealed that the respondents lacked knowledge about themselves as adolescents as well as a lack of knowledge of their reproductive health and development. Furthermore, the results portrayed a lack of knowledge of contraceptives. The study findings may assist health care providers to identify educational programmes on contraception at schools, markets and in the community. / Health Studies / Thesis (M.A. (Health Studies))

This quantitative descriptive cross sectional study explored factors influencing sexual risk behaviours among youths in senior secondary schools in Ethiopia. Data were collected using structured questionnaires. Religious attachment, living with friends, living alone, parental control, level of parental education, peer pressure and number of friends who had experienced sex were some of the factors noted to influence youths to engage in sexual risk behaviours. The findings of this study have implications for both practice and policy development. They will enable healthcare workers to identify youths at risk of engaging in sexual risk behaviours and subsequently motivate them using health promotion strategies to engage in safe sexual practices. Adopting such an approach will prevent or at least minimise risk of youths being infected with sexually transmitted diseases, such as HIV/AIDS. / Health Studies / M.A. (Health Studies)