Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 187-207).

Background: Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. Methods: We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. Results: Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. Conclusions: Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches. / This work was funded through a sub-grant from the U.S. Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn and Child Survival grant from the Bill & Melinda Gates Foundation, and through a sub-grant from the Partnership for Maternal, Newborn & Child Health. / Revisión por pares / Revisión por pares

Essa tese trata da prática de parteiras na cidade de Melgaço, na região marajoara e fluvial do estado do Pará, no contexto globalizado entre 2004 e 2006. Seguindo uma abordagem antropológica, minha proposta foi me aproximar da “visão nativa”, integrando a prática de parteiras dentro da análise do modo de vida “local”. Optei por centrar a discussão na etnografia pormenorizada da vida cotidiana (práticas e conhecimentos) das parteiras, sem, no entanto, cair no erro de monografias anteriores, isto é, sem me limitar a uma “história natural” do grupo, como se fosse “exótico” e “isolado”. A importância que estas mulheres conferem à atenção da saúde gineco-obstétrica envolveu analisar elementos tão diversos quanto a massagem abdominal empregada (conhecida localmente como puxação), as relações conjugais e de parentesco, a interação com o sistema de saúde institucional e os cursos de treinamento organizados por ONGs. A originalidade dessa pesquisa é pretender suplantar as dicotomias usuais (tradição/modernidade, biológico/cultural etc.), além da preocupação funcionalista (como modificar as práticas locais), para ressaltar a dimensão social (redes familiares etc.) e simbólica (saberes locais, hierarquias de prestígio) que englobam os elementos que vêm “de fora”, conferindo um sentido à prática atual das parteiras. / This thesis addresses the practice of midwives in the city of Melgaço, in the fluvial region of the Marajó, State of Pará, in the globalized context from 2004 to 2006. Following an anthropological approach, my intention was to become closer to the “native view”, integrating midwives’ practice within the analysis of the “local” way of life. I chose to center this discussion on a detailed ethnography of the midwives’ daily life (practices and knowledge) without, although, committing the mistake of previous monographies, that is, without limiting myself to a “natural history” of the group, as if they were “exotic” and “isolated”. The importance that these women confer to gynecological and obstetrical health issues involved the analysis of elements as diverse as the abdominal massage (known locally as puxação), the kinship and marital relations, the interaction with the institutional health system and the training courses organized by NGOs. The originality of this research is to intend to overcome usual dichotomies (e.g. tradition/modernity, biological/cultural etc.), beyond the functionalist worries (how to modify the local practices), in order to enhance the social (family networks etc.) and symbolic (local knowledge, prestige hierarchies etc.) dimensions that involve the elements coming “from outside” and that confer a meaning to the current practice of these midwives.

The Sultanate of Oman’s health system has developed rapidly since 1970, with the discovery of oil as well as the strong central government of Sultan Qaboos bin Said. However, despite its investment and dedication to improving the health care available to its citizens, Oman has just begun to address concerns linked to cultural beliefs and social perceptions, including mental health and reproductive health. This study examines how the government has addressed mental and reproductive health, the realities on the ground, and the ways in which cultural perceptions and recent social change influence these health challenges. This study is based on semi-structured interviews with Omani health professionals that have been used to identify hurdles as well as opportunities that exist to strengthen the quality of care in these newly emerging fields in the Omani public health system.

For every method, there's a story - the IUD that almost killed her, the male birth control that almost happened, the weight gained and the moods changed. Whether a narrative of personal experience or one heard through the grapevine, stories about contraception illuminate critical issues in reproductive health today. Using ethnographic data deeply colored by ongoing partisan rhetoric around reproductive rights and the body, I discuss the dynamics of power at play in patient experience, the performance of social complaint and institutional critique, and vernacular conceptualizations of health and embodiment in the contraceptive regimen.

Doctor of Philosophy / Department of Kinesiology / Katie M. Heinrich / Tactical athletes (e.g., law enforcement, military, firefighters) require a proportionate fitness level, along with specific technical and tactical skills, to achieve short-term objectives and disable various threats. Although these professions have unique job duties and workplace exposures, tactical athletes share many commonalities. A tactical athlete’s occupation requires her to be physically prepared for the unknown to protect the public. So what happens when the tactical athlete becomes pregnant? Benefits of physical activity throughout pregnancy for athletes, non-athletes, and baby have been well-documented. However, certain common tactical occupational conditions may result in adverse birth outcomes. These include shift work, high job stress, and exposures such as lead handling or high ambient temperatures. Additionally, extreme physical exertion around the implantation period may harm the developing embryo. In an unpredictable, potentially extremely physically demanding and stressful job environment, the pregnant tactical athlete may have higher risk for adverse birth outcomes compared to other women. The purpose of this dissertation was to examine the reproductive health of physically active females with specific focus on tactical athletes. First, we wanted to determine any exercise limits for pregnant athletes. We were also interested whether reproductive health was an important concern for this population, and if their adverse birth outcomes were higher compared to the United States national average. Chapter one reviews the literature, examining the female athlete and tactical athlete, the physical and occupational demands of tactical professions, and the reproductive health concerns among law enforcement officers (LEOs) and firefighters. Chapter two is a comprehensive review on prenatal exercise. It highlights the lack of scientific rigor presented in earlier guidelines, and states the need for more research on the upper limits of exercise intensity for athletes. Female athletes can usually maintain regular exercise training during pregnancy. Chapter three uses grounded-theory to investigate reproductive health concerns among firefighters. Results indicate that reproductive health is unquestionably a large concern, with four resulting themes (i.e., decision-making, recruitment and retention, policy variation, and lack of research). Chapter four investigates adverse reproductive health outcomes in female LEOs. Miscarriage rates are compared with a large prospective linkage study, preterm birth rates are compared to a large systematic US review study, and links are explored between specific job exposures and pregnancy loss. Miscarriage rate for our population are 19.1%, and preterm birth rates are 16.4%, both significantly higher than US averages. Physical activity, including strenuous occupational demands during pregnancy, is not associated with pregnancy loss among female LEOs. Chapter five presents a findings summary and future research directions. Miscarriage and preterm birth appear to be higher than average for both female firefighters and LEOs. Exercise did not play a large role in the concerns of female firefighters, or findings from female LEOs. Future research should be conducted specifically on females working in tactical occupations, with an emphasis on reproductive health concerns. More education should be provided at the organization level on the potential occupational exposures that can cause increased risk of adverse birth outcomes in female tactical athletes.

Made available in DSpace on 2015-01-26T13:21:20Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-04-29Bitstream added on 2015-01-26T13:30:40Z : No. of bitstreams: 1 000793448.pdf: 1279649 bytes, checksum: 88fcbcd27bf56f6671258bc192312af3 (MD5) / As questões relacionadas à sexualidade e à saúde sexual e reprodutiva dos adolescentes são objeto de preocupação dos diversos setores sociais. Dentre os estudos sobre a juventude, a gravidez na adolescência tem sido objeto privilegiado, muitas vezes evidenciando discursos pautados em percepções preconceituosas, punitivas e associadas à irresponsabilidade e exposição a riscos. As discussões centram-se na mulher e com menor ou nenhum enfoque, na paternidade. Assim, há um esquecimento do adolescente homem que, na maioria das vezes, não encontra seu espaço junto às politicas públicas, principalmente quando se trata de gravidez na adolescência. Desta forma, o presente estudo tem como objetivo compreender as representações sociais sobre o processo de paternidade; o tornar-se pai e apreender os significados e as vivências estabelecidas neste processo. A pesquisa foi realizada com 9 adolescentes com 17 e 18 anos, moradores de um bairro periférico no municipio de São Manuel-SP. Considerando o objeto de estudo, adotou-se como referencial teórico as Representações Sociais e como recurso metológico a pesquisa qualitativa, com uma entrevista semi- estruturada. Ao término da coleta, as entrevistas foram transcritas e submetidas à técnica de análise de conteúdo de Bardin. A partir dessa técnica foram identificadas três categorias centrais: a descoberta da gravidez; dificuldades e mudanças vivenciadas pelo adolescente ao tornar-se pai e o significado da paternidade. Após análise dos dados, constatou-se que a vivência da paternidade trouxe mudanças significativas na vida destes adolescentes, tanto no plano econômico, como também no afetivo, pessoal e social. Destaca-se que essa experiência gerou sentimentos de satisfação ao ultrapassar a função de ser apenas um pai provedor, o que é mostrado pelo cuidado com o filho e principalmente através do estabelecimento de relações afetivas entre estes / Issues related to sexuality and to reproductive and sexual health of adolescents is a main concern of many social sectors. Among the studies on youth, teen pregnancy has been privileged, often revealing speeches guided by punitive and prejudicial perceptions, which are associated with irresponsibility and exposure to risks. The discussions focus almost solely on women, with less or no focus on fatherhood. Thus, there is a forgetfulness of the teenage man, who most often doesn’t find his place together with public policies, especially when it comes to teen pregnancy. Thereby, this study aims to understand the social representations about the paternity process and to grasp the meanings and experiences set forth in this process. The survey was conducted with 17 adolescents from 9 to 18 years old, residents of a suburb in the municipality of São Manuel - SP. According to the object of study, the Social Representations were adopted as the theoretical framework, and the qualitative research as a methodological resource, together with a semi-structured interview. At the end of the collection, the interviews were transcribed and subjected to the content analysis technique of Bardin. From this technique, three core categories were identified: the discovery of pregnancy, difficulties and changes experienced by adolescents when becoming fathers and the meaning of fatherhood. After analyzing the data, it was found that the experience of fatherhood has brought significant changes in the lives of these adolescents in economic, emotional, personal and social terms. It is noteworthy that this experience has generated feelings of satisfaction to overcome the function of being just a provider father, which is shown by caring for their child and primarily through emotional relationships between them

Here we show the extent to which the expected world population growth could be lowered by successfully implementing the recently agreed-upon Sustainable Development Goals (SDGs). The SDGs include specific quantitative targets on mortality, reproductive health, and education for all girls by 2030, measures that will directly and indirectly affect future demographic trends. Based on a multidimensional model of population dynamics that stratifies national populations by age, sex, and level of education with educational fertility and mortality differentials, we translate these goals into SDG population scenarios, resulting in population sizes between 8.2 and 8.7 billion in 2100. Because these results lie outside the 95% prediction range given by the 2015 United Nations probabilistic population projections, we complement the study with sensitivity analyses of these projections that suggest that those prediction intervals are too narrow because of uncertainty in baseline data, conservative assumptions on correlations, and the possibility of new policies influencing these trends. Although the analysis presented here rests on several assumptions about the implementation of the SDGs and the persistence of educational, fertility, and mortality differentials, it quantitatively illustrates the view that demography is not destiny and that policies can make a decisive difference. In particular, advances in female education and reproductive health can contribute greatly to reducing world population growth.

Although abortion has been decriminalized in Canada since 1988 and is covered as a medically necessary service through territorial health insurance schemes, anecdotal evidence suggests women in Canada’s north face significant barriers to accessing care. With a population of fewer than 34,000 spread across an area that is larger than California, geographic remoteness impacts health care access and quality in Yukon Territory. This qualitative study aimed to explore the dynamics shaping access to abortion care in the Yukon, provide an opportunity for women to share their experiences, and identify possible avenues for improving service delivery. In 2015-2016, the study team conducted 16 in-depth interviews with women and 11 key informant interviews. We used an iterative analytic approach allowing for the identification of emerging codes and themes. Our findings reveal that women face a number of barriers when accessing abortion services in Yukon. Specifically, a physician referral is required, as are several pre-procedure appointments, with no one central location to obtain these services. Women expressed concerns of privacy, overcoming logistical constraints, lengthy wait times, and lack of follow-up supports. Challenges were further amplified for women residing outside of Whitehorse, the sole location to obtain abortion services in the territory. Facilitating efforts to create a more transparent and streamlined service would ease the process for women seeking care and appears warranted. The recent registration of mifepristone could serve to alleviate certain barriers, presuming that the approved regimen is affordable, evidence-based, and available at more service delivery points. Bien que l'avortement a été décriminalisé au Canada depuis 1988 et est couvert en tant que service médicalement essentiel par le biais des régimes d'assurance-santé territoriales, des évidences non confirmées suggèrent que les femmes vivant au Nord du Canada font face à des obstacles importants quant à l'accès aux soins. Avec une population de moins de 34,000 habitants répartit sur un territoire d’une superficie supérieure à celle de la Californie, les effets de l’éloignement géographique sur l'accès et la qualité des soins de santé dans le territoire du Yukon sont considérables. Cette étude qualitative visait à explorer la dynamique qui façonne l'accès aux services d'avortement au Yukon, fournir une occasion pour ces femmes de partager leurs expériences et d'identifier les alternatives possibles pour améliorer la prestation de ces services. En 2016-2016, l’equipe de recherche a effectué 16 entrevues avec des femmes et 11 entrevues avec des informateurs/acteurs clés, et avons utilisé une approche analytique itérative permettant l'identification d’une codification et des thèmes émergents. Nos résultats démontrent que les femmes font face à un certain nombre d'obstacles lors de l'accès aux services d'avortement au Yukon. En effet, une recommandation médicale est requise, de même que plusieurs rendez-vous pré-procédure et un manque de services centralisés. Les atteintes à la vie privée, les contraintes logistiques, les longs temps d’attente et le manque de suivi sont des contraintes exprimées par nos participantes. Ces défis sont encore plus important pour les femmes habitant à l'extérieur de Whitehorse qui est le seul endroit pour obtenir des services d'avortement sur le territoire. Promouvoir les efforts visant à créer des services plus transparents et simplifiés faciliteraient le processus pour les femmes qui requiert des soins et semblent nécessaires. La récente introduction de la mifépristone pourrait alléger certains obstacles, en supposant que le médicament adopté est abordable, fondé sur des preuves scientifiques, et disponible à plusieurs points de services.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Information Technology in the Faculty of Informatics and Design, at the Cape Peninsula University of Technology / Transitioning from childhood to adulthood is typically coupled with many puberty related challenges, and such challenges are heightened by access deficiency to reproductive health information. The situation is worsened in under-resourced communities in Southern Africa as the youth’s socio-economic status is hampered by a lack of timely informed education. Such youth groups are referred to as youth-at-risk. The youth are the most affected in recent days as they are exposed to various health disturbances. The youth need to be aware of critical life information, particularly reproductive health information, in order to make better choices. With mobile technology being an integral part of everyday life and more appealing to the youth, opportunities are opened up for the use of mobile functionalities or an extension thereof to provide relevant mobile-based services for information access. Recently, health information is shared and is accessible on different mobile platforms. This research project focuses on mobile-based services to promote reproductive health information for youth-at-risk groups, aged 18 to 24 from the Grabouw community in the Western Cape of South Africa. Most of mobile technology’s solutions and proposed mobile-based services come from elsewhere with little or no consideration of the communities and people who will use these services. The youth was engaged in different activities as participants to design a mobile-based service to promote reproductive health information, putting them at the center of the design process as design partners. Service design methods and tools were used as the methodology in a systematic manner. A Double Diamond framework consisting of four phases (Discover, Define, Develop and Deliver) was followed in order to collect the data. The phases guided the design process from ideation to co-designing of the service prototyped herein. Different ways of accessing information especially reproductive health information by youth-at-risk were identified. The available technology and existing practices to access reproductive health information were also identified. Results clearly indicate that the youth are motivated to use mobile phones to share and receive health information. The youth currently have access to reproductive health information and services, however some services require the youth to travel long distances by vehicle or by walking. The youth walk as a result of lack of transport in some locations because there is no infrastructure in place to support vehicles. Furthermore, the information available to the youth currently is not contextualised, therefore making it irrelevant with consideration to resources available in this particular community. The research project recommends that when a solution is being designed for any community, all the relevant stakeholders have to be involved in the design and development process to allow for a co-design interaction that allows for a usable and relevant solution design with and for the intended users. Involving the user in the design process accelerates adoption if an innovation and easy technology appropriation in the user’s environment. The users add the value needed as they are sharing knowledge, experiences and way of doing things which have a positive effect on the solution. The study recommends service to be developed in the future according to the findings herein. The implementation, testing and use of the mobile-based service (RHIAY) prototyped in this thesis are for future work.