Early sexual debut whether voluntary or coerced increases exposure to high risk sex which leads to unplanned pregnancy, sexually transmitted infections including HIV and reproductive heal th problems during adolescence. This study aim s to examine the risk factors for age of sexual debut, either voluntary or coerced among Black African female adolescents from the Birth to Twenty cohort study in Soweto, South Africa . Part A is the study protocol which outlines the rationale for conducting this study , study aim, research methodology, analysis plan and ethical considerations. Part B forms the literature review which gives a summary of the existing literature and provides context for the dissertation. The objectives of the literature review were to identify published literature on determinants of either voluntary or coerced sexual debut in adolescents and identify gaps for further research. Part C is the manuscript presenting the results and discussion on the implications of key findings. The results showed that there are many Black African female adolescents who are engaging in early sexual debut and there is prevalenc e of coerced sexual debut among adolescents of similar age. Socio-economic status and maternal education were found to be significantly associated with coerced sexual debut. There is a need for interventions to delay sexual debut among young female adolescents from low socio-economic backgrounds and lower maternal education.

acase@tulane.edu / 1 / Lindsay Bartlett

DNUR / Sexual and reproductive health services include family-planning or contraception, pre-natal care, safe births and post-natal care, safe and accessible post-abortion care and where legal, access to safe abortion services, prevention and treatment of sexually transmitted infections and cervical cancers, sexual health information, and counselling. Adolescents face many sexual and reproductive health risks, ranging from teenage pregnancy, early unprotected sex, and sexually transmitted infections. Every year one in twenty young people worldwide contracts sexually transmitted infections, and currently, fifty percent of HIV infections occur in young people aged 15-24 years. Teenage pregnancy is at alarming rate among school girls. The overall aim of this study was to develop a comprehensive sexual and reproductive health programme for secondary school learners in Capricorn and Mopani Districts of Limpopo Province, South Africa. Three objectives which guided programme development were: 1. to assess the knowledge of secondary school learners about SRH issues, 2. to assess teachers’ views about the impact of the existing SRH programmes for adolescents and 3. to explore the perceptions of parents towards the provision of SRH services in schools. Sequential mixed methods approach was used where the initial quantitative phase was followed by qualitative phase. Three steps were used as the basis for developing the programme. Step 1 used quantitative descriptive survey to assess the knowledge of learners about sexual and reproductive health issues. Step 2 also used quantitative descriptive survey to assess teachers’ views about the impact of the existing sexual and reproductive health programmes provided in schools. An exploratory qualitative method was used in step 3 to explore the perceptions of parents towards the provision of sexual and reproductive health services in schools. The study population comprised of learners, teachers and parents. Probability and non-probability sampling methods were used. Self-administered questionnaires were used to collect quantitative data from learners and teachers, while in-depth face-to-face interviews were used to collect qualitative data from parents. Quantitative data was analysed using Statistical Package for the Social Sciences version 23. Qualitative data was analysed using Techs’ technique. Reliability and validity as well as trustworthiness were ensured. Ethical principles were adhered to throughout the study. Results indicated that (63%; n=69) learners were sexually active lacked knowledge about contraception (80%; n=40), STIs (38%; n=32) and (33%; n=37) had been pregnant and the mean age was 17. Eighty six (86%; n= 97) reported inaccessibility to sexual and reproductive health services. About (55%, n= 19) teachers were found to be inadequately trained and lacked training manuals. Most teachers reflected ineffectiveness of the existing programmes as evidenced by high pregnancy rates. Parents reflected difficulty in communicating sexual and reproductive health issues with teenagers and lack of knowledge, thus indicating the importance of the programme in schools. Parents also indicated the relevancy of teachers in facilitating the programme and collaboration between the Department of Education and the Department of Health. Dickoff’s six elements of the survey list was used to develop the programme. Programme validation was done by involving participants to evaluate it by completing questionnaires. The programme will empower learners to deal with sexual and reproductive health issues, resulting in decreased teenage pregnancy and other sexual risks. Collaboration and support were the recommendations directed to both the Department of Education and the Department of Health. Further research was also recommended. / NRF

With nearly 13% of maternal deaths being attributed to unsafe abortion there is a need to implement new strategies to improve access to safe services. As developing regions and legally restricted areas lead these numbers, further evidence must be presented demonstrating tailored and actionable strategies for these settings. In Pakistan abortion is legally restricted and the country continues to face a high burden of maternal death and disability, much of which is directly or indirectly attributable to unsafe abortion. The community-based distribution of misoprostol for early abortion has the potential to reduce harm from unsafe abortion in Pakistan and other low-resource settings where abortion is legally restricted. This study employed a multi-methods approach to evaluate this intervention in Sindh, Pakistan and consisted of a logbook review, interviews with lay providers, and in-depth interviews with program beneficiaries. Our results suggest that the community-based distribution of misoprostol is an effective and promising strategy for improving access to safe abortion care. Efforts to implement or strengthen similar programs appears warranted.

Barriers to interbreeding limit gene flow between sister taxa, leading to reproductive isolation and the maintenance of distinct species. These barriers come in many forms, and can act at different stages in the reproductive process. Pre-copulatory barriers may be due to individuals discriminating against heterospecifics in mate choice decisions. These decisions may be informed through a range of sensory modalities. If a female is mated and inseminated, then there may be multiple postmating-prezygotic barriers that affect the success of heterospecific sperm in attaining fertilisations. Post-zygotic barriers can be very early acting, resulting in embryonic fatality, or may be later acting, affecting the fitness of hybrid offspring. In this thesis I investigate potential reproductive barriers between the interbreeding field crickets Gryllus bimaculatus and G. campestris. I find that females of both species show only weak preference for conspecific calling song, and may even respond phonotactically to songs typical of heterospecific males. Female G. bimaculatus are repeatable in their preferences and strength of response. G. bimaculatus females presented with synthetic songs prefer those with longer inter-pulse intervals, whereas G. campestris show no discrimination between these songs. Upon meeting, G. campestris females strongly discriminate against heterospecific males, behaving aggressively towards them. This is likely driven by females responding to close range species recognition cues, including chemoreception. The species differ in their cuticular hydrocarbon profiles, and females that are no longer able to use their antennae to receive chemosensory information reduced their aggressive behaviour towards heterospecific males. G. bimaculatus females will mate with heterospecific males, though less readily than to conspecifics. When sequentially mated to both conspecific and heterospecific males, these females will preferentially take up and store sperm from the conspecific male, and sperm from conspecific males is more likely to sire offspring than would be predicted from the proportion of sperm in storage. Eggs from inter-species mating pairs are less likely to begin embryogenesis, and are more likely to suffer developmental arrest during the early stages of embryogenesis. However hybrid embryos that survive to later stages of development have hatching success similar to that of pure-bred embryos. After mating, phonotaxis of G. bimaculatus females towards male songs follows a pattern of suppression and subsequent recovery, likely triggered through detection of seminal proteins transferred in the male ejaculate, or detection of mechanical filling of the spermatheca. This pattern of suppression and recovery of phonotaxis does not differ between females mated to conspecific or heterospecific males. Females that lay few or no eggs do not experience a refractory period.

This thesis investigates the role of masculinities on men’s sexual and reproductive health in Botswana. Botswana is currently in the throes of a severe heterosexually driven HIV/AIDS epidemic that has eroded some of the developmental gains the country had achieved since independence. A unique feature of Botswana’s HIV epidemic is the rapid and phenomenal increase in infection and prevalence rates in the face of good levels of knowledge of HIV prevention and an early and comprehensive HIV prevention strategy that guaranteed access to free HIV prevention and treatment services, including ARV treatment. The lack of effectiveness of the country’s HIV efforts and subsequent increase in infection rates have been blamed on men’s risky sexual behavior and lack of support of their partners’ decisions to utilize these services. In fact, quantitative studies on men’s sexual behavior and HIV such as the Botswana AIDS Impact Surveys show that men are less likely to use VCT services and more likely to engage in risky sexual behavior that increases risk of HIV infection to themselves and their partners. While studies provide the evidence that implicates men in the rapid growth Botswana’s HIV epidemic, the studies provide little or no explanation of factors that motivate men’s behavior in reproductive health. This lack of insights on factors that motivate men’s behavior leads to stereotypes about male promiscuity and may contribute to the lack of effectiveness of HIV prevention strategies. The current HIV epidemic has thus thrust heterosexual masculinities at the centre of HIV prevention efforts and provides an opportunity for research to interrogate the role of heterosexual masculinities in reproductive health, especially HIV transmission and prevention. The thesis employs qualitative data to provide in-depth appreciation of the prevalent masculine norms and beliefs and to highlight contextual factors and processes that shape and give rise to various masculinities. It further uses quantitative data to provide measures of levels of men’s masculine and gender role beliefs that may influence HIV prevention and transmission and to test the association between masculinities and men’s sexual and reproductive health attitudes and practices. The results show that men’s sense of identity is socially constructed, and revolves around the notion of superiority to women, independence and having and being in control of the family. However, men face many challenges to the realization of this masculine ideal. Men’s perceived difficulty or failure to live up to socially constructed Men, Masculinities and Sexual and Reproductive Health in Botswana vii notions of masculinities affects their experience of sexual and reproductive health programs, especially women’s empowerment and HIV prevention programs. By their nature, these programs tend to challenge men’s dominance of women’s decision on sexuality, and are therefore experienced as a threat to some men’s sense of identity. Quantitative results indicate an association between masculinities and sexual and reproductive health. While men’s sense of masculinities is not the overriding factor determining their sexual and reproductive health attitudes and practices, the results show a strong association traditional masculine beliefs and negative sexual and reproductive health beliefs and practices. However, there is also strong evidence that men and masculinities are responding to contextual factors, such as the HIV epidemic, which has become a specific stress on the local construction of masculinities. In focus group discussions, many men challenged traditional masculine norms, beliefs and practices that increase their vulnerability to HIV infection and those that either encourage or condone violence within intimate relationships. Significantly high proportions of men had positive attitudes towards HIV prevention programs. It is evident that now more than ever (and thanks to the HIV/AIDS epidemic) many men are ready to question the predominant masculine norms, beliefs and practices that increase their vulnerability to infection and disease. These voices of change represent a window of opportunity for research and programs can meaningfully engage with men and masculinities on issues of sexuality, gender roles, sexual and reproductive health and HIV/AIDS prevention and transmission. There is need for future research and interventions to move away from focusing exclusively on individual models of preventive health behaviors to more multilevel, cultural and contextual explanations. Taking account of multilevel, cultural and contextual factors that shape masculinities and men’s sense of identity will ensure increased effectiveness of sexual and reproductive health programs, especially HIV/AIDS prevention programs. On the other hand, failure to account for cultural and contextual factors that shape individuals’ behavior will only ensure that the shortcomings of such intervention program will continue to be blamed on the individual.

In this field study, female social workers perspectives have been collected, on interventions regarding sexual and reproductive health in the public sector in Argentina. The purpose was primary empirical and secondary to analyze empirical data using critical theory. The methodology was qualitative and the theoretical framework was created using an abductive approach. Thirteen female social workers were interviewed in the municipality of general Pueyrredón, in the province of Buenos Aires. Empirical data was categorized using the hermeneutic approach; described and analyzed using critical theory. Results presented challenges regarding lack of accessibility, continuity and accountability, from the nation, the province and the municipality. Moreover, results show challenges on how to target vulnerable groups, adolescents, people with low intellectual disability, people from neighboring countries, and from the north of Argentina. In addition, there were challenges on how to increase correct use and use of contraceptives. Suggestions were to make interventions more adaptable and creative. Stressed challenges were regarding male involvement in sexual and reproductive health decisions, gender violence, the patriarchal society, and the macho culture. Critical theory highlighted challenges created by Argentina’s societal structures, structures that contribute to oppression of service users, making them powerless and marginalized. By increasing the knowledge of critical social work theory in social work education, there would be more tools for social workers to use it in practice. When using critical social work theory all levels in a society shall be included. Specific policies and interventions are requested to battle female discrimination.

Young men are at the greatest risk of contracting sexually transmitted infections (STIs) within the U.S. male populations, yet are the least likely to make a sexual and reproductive health (SRH) care visit. Clinical approaches in these areas that include the outreach to and the involvement of male partners of female patients can prove particularly useful in expanding SRH care to men and can also improve health outcomes for women who have sex with men. In this study I examined UCF's healthcare provider's approaches to educate and involve men (between the ages of 18 and 30) and male partners of female patients in their SRH needs. I conducted qualitative semi-structured interviews with 18 health care providers at the Student Health Center; including physicians, physician assistants, and registered nurses. This study found that there were significant differences in perception of men's SRH risk behaviors among the providers. In addition, this study revealed issues that might deter male students from accessing care, specifically how patients are required to state to the operator (who is also an undergraduate student) their name, PID and exactly why they are scheduling a visit to the clinic, thus many men say they have cold symptoms instead of issues with SRH. This study is significant because it can contribute to improvements in the delivery of SRH care to male students on campus.

Since 2015 Canada has welcomed 44,620 Syrian refugees. The research on Syrian refugees in Canada has mainly focused on their immediate health needs, communicable diseases, and chronic illnesses. Aside from maternal health, the sexual and reproductive health (SRH) needs of Syrian refugee women is undocumented in Canada. To address this gap in the literature we conducted a qualitative study in Ottawa, Ontario that involved in-depth interviews with Syrian refugee women and individuals who provide health services to them. When accessing SRH services Syrian women identified a preference for women providers, faced difficulty adjusting to societal norms during the perinatal period, felt that contraception counselling was not culturally informed, and struggled with their maternal mental health. Key informants mainly echoed these findings and expressed a need for more cultural competency/humility training, interpretation services, and trauma-informed counselling. The path to improving SRH services for Syrian women is complex, but highly warranted.

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