Bakgrund: Ungdomars sexuella och reproduktiva hälsa och rättigheter (SRHR) är ett viktigt folkhälsoarbete och barnmorskan har en central roll när det kommer till att nå ungdomarna med kunskap och information. Det förefaller finnas få studier om barnmorskors uppfattningar om vad ungdomar behöver veta mer om när det kommer till deras sexuella och reproduktiva hälsa och rättigheter. Syfte: Syftet med denna studie var att beskriva barnmorskors uppfattningar om vad ungdomar behöver veta mer om inom området sexuell och reproduktiv hälsa och rättigheter. Metod: Kvalitativ intervjustudie med åtta semistrukturerade intervjuer med barnmorskor. Datamaterial analyserades med en kvalitativ innehållsanalys med induktiv ansats. Resultat: Barnmorskorna uppfattade att ungdomarna hade behov av att veta mer om kroppsutveckling. Även mer om sexuellt överförbara infektioner (STI) och preventivmedel samt att killarna behövde veta mer om deras reproduktiva ansvar. Ungdomarna behövde också veta mer om sexuella relationer och rättigheter, innefattande bland annat lagar och homosexualitet. Barnmorskorna ser idag en ökning av sexuella problem bland ungdomarna och barnmorskorna hade en gemensam uppfattning om att det beror på pornografikonsumtion. Slutsats: Barnmorskor har insikt i vad ungdomar behöver veta mer om inom SRHR. Det finns fortfarande brister i undervisning och utbildning till ungdomar inom SRHR och det är angeläget att fokusera och investera i arbeten för att stärka och främja ungdomars SRHR. Klinisk tillämpbarhet: Denna studie lyfter barnmorskors uppfattningar om vad ungdomar behöver veta mer om inom ämnet SRHR. Studien kan användas i klinisk verksamhet till förbättringsarbeten för olika yrkeskategorier som arbetar med ungdomar gällande SRHR. / Background: The sexual and reproductive health and rights (SRHR) of young people is an important public health work and the midwife has a central role in reaching the young people with knowledge and information. There seem to be few studies on midwives' perceptions about what young people need to know more about when it comes to their sexual and reproductive health and rights. Purpose: The purpose of this study was to describe the views of midwives about what young people need to know more about in the area of sexual and reproductive health and rights. Method: Qualitative interview study with eight semi-structured interviews with midwives. The data material was analyzed with a qualitative content analysis with inductive approach. Result: The midwives perceived that the young people needed to know more about body development. In addition, more about sexually transmitted infections (STIs) and contraceptives and that the young men needed to know more about their reproductive responsibilities. The youth also needed to know more about sexual relations and rights, including, among other things, laws and homosexuality. The midwives today see an increase in sexual problems among young people and the midwives had a common view that this is due to pornography consumption. Conclusion: Midwives have insight into what young people need to know more about in SRHR. There are still shortcomings in education for young people within SRHR, and it is important to focus and invest in work to strengthen and promote young people's SRHR. Clinical application: This study highlights the views of midwives on what young people need to know more about in the subject of SRHR. The study can be used in clinical activities for improvement work for various occupational categories that work with young people regarding SRHR.

Objetivo: Descrever a iniciação sexual e o uso de métodos anticoncepcionais e estimar fatores associados a estas condutas, em adolescentes de 13 a 17 anos de idade, de escolas da rede pública de ensino secundário da Ilha de Santiago, Cabo Verde. Métodos: Estudo transversal realizado com amostra probabilística e representativa de 768 adolescentes com idade entre 13 e 17 anos, de escolas secundárias públicas da Ilha de Santiago em 2007. A associação foi testada pelo teste de proporção, qui-quadrado de Pearson ou Fisher e regressão logística. Para estimar os fatores associados ao uso de métodos anticoncepcionais e preservativo, foi analisada a sub-amostra de 368 adolescentes sexualmente ativos. O início da vida sexual, o uso de métodos anticoncepcionais e o uso de preservativo foram analisados como desfechos. Foram consideradas variáveis independentes: características sociodemográficas, afetivo-sexuais e comportamentais. Foi utilizada regressão logística para análise simultânea dos fatores, considerando-se nível de significância de 5%. Resultados: Entre os adolescentes do sexo masculino, os fatores associados ao início da vida sexual foram: idade maior que 14 anos, ser católico e consumir bebidas alcoólicas. Entre as adolescentes do sexo feminino, possuir mais de nove anos de estudo e parceria afetivosexual foram associados ao início da vida sexual. Entre os 368 adolescentes, 69,3% referiram ter usado métodos anticoncepcionais na sua última relação sexual, sendo mais freqüentes o preservativo (94,9%) e a pílula (26,4%). Fatores significativos e positivamente associados ao uso de métodos anticoncepcionais na última relação foram: morar em município da capital (OR=2,02; IC95%: 1,23;3,32), ter namorado anteriormente à época da entrevista (OR=2,82; IC95%: 1,51;5,26) e ter mais de oito anos de estudo (OR=2,03; IC95%: 1,23;3,33). A prevalência de uso de preservativo na última relação sexual foi de 94,9%. Fatores associados ao uso de preservativo na última relação foram: religião não católica (OR=0,68, IC 95%: 0,52;0,88) e parceria afetivo-sexual no período anterior à pesquisa (OR = 5,15, IC 95%: 1,79; 14,80). Conclusões: Ao contrário de outros contextos da África Subsaariana, foram constadas taxas elevadas de uso de preservativo por adolescentes no início da vida sexual. Os adolescentes podem iniciar a vida sexual de maneira mais segura se tiverem informação, educação sexual e acesso a métodos de prevenção à gravidez e IST. O elevado uso de preservativo e a associação entre escolaridade e utilização de métodos anticoncepcionais entre adolescentes na última relação sexual podem expressar resultados positivos das políticas de saúde sexual e reprodutiva atuais, contribuindo para diminuição da infecção por HIV. Todavia, a influência da religião e da parceria afetivo-sexual no uso de preservativo revela a necessidade de ações de prevenção voltadas para segmentos religiosos não católicos e que não possuem parceria afetivo-sexual. Este estudo oferece elementos para a reflexão sobre o delineamento de políticas de redução da vulnerabilidade dos jovens às IST/Aids e sobre os limites e desafios da promoção do uso do preservativo e educação sexual focando as relações desiguais de gênero. / Objective: To describe the onset of sexual life and the use of contraceptive methods and to estimate factors associated among adolescents aged 13-17 years from public high schools in Santiago Island, Cape Verde. Methods: A cross-sectional study with a probabilistic and representative sample of 768 adolescents aged 13-17 years from public high schools was carried out in Santiago Island, Cape Verde, in 2007. The association was verified by means of test of proportions, Pearsons chi-square, Fishers exact and logistic regression. The subsample of 368 sexually active adolescents was analyzed to estimate the factors associated with contraceptive methods and condom use. The first sexual intercourse and contraceptive methods and condom use were analyzed as outcomes. Sociodemographic, sexual-affective and behavioral characteristics were the independent variables. Logistic regression was used for simultaneous analysis of factors at a 5% significance level. Results: Among male adolescents, the factors associated with the first sexual intercourse were: age over 14 years, being catholic and alcohol consumption. For female adolescents, having more than nine years of schooling and sexual-affective partnership were associated with the first sexual intercourse. Among the 368 adolescents, 69.3% reported use of contraceptive methods in the last sexual intercourse; the most frequent methods were condom (94.9%) and pill (26.4%). Significant and positive factors associated with the use of contraceptive methods in the last sexual intercourse were: living in the capital (OR=2.02; 95%CI: 1.23;3.32), having dated previously the study (OR=2.82; 95%CI: 1.51;5.26) and having more than eight years of schooling (OR=2.03; 95%CI: 1.23;3.33). The prevalence of condom use in the last sexual intercourse was 94.9%. Factors associated with condom use in the last sexual intercourse were: being non-catholic (OR=0.68, 95%CI: 0.52;0.88) and having affective-sexual partnership previously the study (OR=5.15, 95%CI: 1.79;14.80). Conclusions: Contrary to other Sub-Saharan Africa contexts, high rates of condom use in adolescents first sexual intercourse were observed. Adolescents are able to begin sexual life more safely as long as they are provide with information, sexual education and access to contraceptive and STI prevention methods. The high condom use and the association between schooling and contraceptive methods utilization in the last sexual intercourse may express positive outcomes from the current sexual and reproductive health policies, accounting for the decrease in HIV infection. However, the influence of religion and sexual-affective partnership on condom use indicates the need for preventive measures targeted at noncatholic groups and those without affective-sexual partnership. This study contributes for the reflection upon the design of policies aimed at reducing the vulnerability of young people to STI/AIDS and the limits and challenges to promote condom use and sexual education focusing on gender inequalities.

This thesis explores women’s experiences of maternal birth injuries, focusing on how gender and sexuality norms affect diagnostics, everyday life and healthcare in Sweden. The empirical material consists of 383 answers to an online questionnaire. The theoretical approaches are centred on how bodies are viewed and valued in a Western society, especially in connection to the social construction of health and illness in relation to gender and reproduction. Existing medical descriptions of maternal birth injuries are explored in comparison to the participants’ own definitions. No clear definition is found and the analysis demonstrates that maternal birth injuries can cause both mental and physical injuries/consequences, arising from both vaginal and caesarean births, and a shift away from mainly focusing on physical damage caused by vaginal delivery is suggested. Everyday life is affected in several ways by the complications that the birth injuries lead to, and many participants suffer severely, both physically and mentally. A majority of the participants seek care for these complications, and their experiences of Swedish healthcare reveal an attitude wherein maternal birth injuries are seen as something normal. Many do not receive sufficient care, if treated at all, and gender and sexuality norms affect how medical personnel act and speak. This demonstrates patriarchal structures, medical hierarchies and heterosexual norms within Swedish healthcare, which devalue female-coded bodies as well as their pain and pleasures. Hence, this thesis addresses the importance of researching the effect of underlying structures on care of women in general, and of maternal birth injuries in particular. / Den här uppsatsen handlar om förlossningsskador och utgår från kvinnors erfarenheter av bemötande och behandling i Sverige. Materialet består av 383 enkätsvar. De teoretiska utgångspunkterna fokuserar på hur kroppar är värderade samt hur sjukdom och hälsa är socialt konstruerade, speciellt i relation till genus och reproduktion i västerländska kontexter. Existerande medicinska förklaringar av förlossningsskador jämförs med deltagarnas egna definitioner och det framkommer att ingen entydig definition existerar. Nuvarande fokus är främst på fysiska skador från vaginala förlossningar men eftersom analysen visar att kejsarsnittsförlossningar också kan leda till förlossningsskador samt resultera i både mentala och fysiska komplikationer/skador, föreslås ett vidgande av innebörden i termen. Vardagen påverkas påtagligt för de flesta med förlossningsskador, och många lider både fysiskt och mentalt. En majoritet av deltagarna har sökt vård men deras erfarenheter av svensk sjukvård visar på flera brister och främst en attityd av att förlossningsskador är något normalt. Flertalet får bristfällig vård om de ens behandlas, och normativa föreställningar om genus samt sexualitet påverkar hur personalen talar och agerar. Underliggande patriarkala maktstrukturer och medicinska hierarkier som nedvärderar kvinnligt-kodade kroppars erfarenheter, lust och smärta blir framträdande. Den här uppsatsen visar därför på vikten av att utforska underliggande strukturers påverkan på vård av kvinnor generellt och speciellt i relation till förlossningsskador.

The objective of the present article is to analyze the process of introducing the regulation of therapeutic abortion into the peruvian governmental agenda, identifying the factors that came together to generate such event, the period of study being between the years 2005 to 2014. The investigation corroborates that said event was possible due to the confluence of certain political and institutional factors on the national stages, the strategy of groups in favor (pro-choice) and against (pro-life) the regulation, and international influence. / El presente artículo tiene como objetivo analizar el proceso de ingreso de la reglamentación del aborto terapéutico en la agenda política gubernamental peruana, así como identificar los factores que confluyeron para generar dicho ingreso, siendo el periodo de estudio entre los años 2005 y 2014. La investigación corrobora que dicho ingreso fue posible gracias a la confluencia de ciertos factores políticos e institucionales del ámbito nacional, de las estrategias de los grupos a favor (pro-elección) y en contra (pro-vida) de la reglamentación, y de la influencia internacional.

Made available in DSpace on 2014-06-11T19:35:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-06-26Bitstream added on 2014-06-13T20:26:24Z : No. of bitstreams: 1 sakamoto_dl_dr_fran.pdf: 859409 bytes, checksum: 7fb448c4c503117bdd0ed371c6d0a9ba (MD5) / Discutir a questão da saúde sexual e reprodutiva de jovens que tiveram filhos na adolescência postulou o enfoque deste estudo, entendendo que a necessidade do envolvimento dos sistemas de proteção social torna-se fundamental para a saúde integral. Pouco se tem estudado a respeito da proteção dessa jovem mulher, a constituição familiar, os processos de reorganização de suas famílias de origem, bem como o papel das políticas públicas nesses contextos. O quadro teórico está fundamentado nos estudos sobre a prevenção e promoção da saúde do MS, OMS, OPAS, PNAD, IBGE e Política Municipal de Saúde e em bases conceituais de Goldani, Machado, Lopes, Rubiol e Bracho entre outros. Participaram do estudo nove sujeitos, dois coordenadores de programas de atenção à saúde de crianças e adolescentes e sete jovens mães usuárias do Sistema Único de Saúde (SUS). A partir de abordagem qualitativa, utilizou-se a entrevista como instrumento de coleta de dados, realizada na Secretaria Municipal de Saúde e Unimed de Ribeirão Preto, SP, e nos domicílios das jovens mães. Os dados foram analisados e agrupados ao redor de temas: saúde e educação de crianças e adolescentes e a realidade no cenário público e privado, vivências de jovens mulheres, o cotidiano familiar e social, sentimentos e significados experimentados pela maternidade, aspectos sexuais e reprodutivos, prevenção e promoção da saúde. As experiências de mães e profissionais retratam a importância dos cuidados com a saúde sexual e reprodutiva, embora a atenção voltada à educação e saúde para essas jovens mães esteja muito aquém da realidade dos programas estudados. Os mesmos se desenvolvem a partir de metas pré-estabelecidas e, segundo análise de conteúdo expressa pelas jovens, essas já não freqüentam mais os bancos escolares, e não estão inseridas nos programas de saúde... / The discussion of sexual and reproductive health in youngsters who have given birth during adolescence has postulated the emphasis of this study, assuming that the involvement of the social protection systems is fundamental for integral health. Little has been researched and studied about these young women, their family constitution, procedures for reorganizing their original families, and the role of public policies within these contexts. The theory is founded on the basis of studies aimed at health promotion and prevention of the Brazilian Ministry of Health, OMS (World Health Organization), OPAS, PNAD, IBGE (Brazilian Institute of Geography and Statistics), City Health Policies, and basic concepts by Goldani, Machado, Lopes, Rubiol and Bracho, amongst others. Nine subjects, two coordinators of programs attending to children and adolescent health, and seven young mothers depending on the Sistema Único de Saúde (SUS) (Unified Health System) have taken part in this study. Using the qualitative approach, interviews were the main resource to collect information, and were performed at the City Health Office and Unimed, in the city of Ribeirão Preto, SP, and at the residence of the subjected young mothers. The data collected was analyzed and classified according to the following themes: children and adolescents health and education and the reality of the public and private scopes; young women life experiences; family and social daily life; feelings experienced due to maternity; sexual and reproductive aspects; prevention and health promotion. Such experiences as described by the mothers and professionals reiterate the importance of sexual and reproductive health care, albeit the attention given to these young mothers concerning health and education is highly lacking when compared to the reality of the social programs studied...(Complete abstract, click electronic access below)

Kvinnor har rätt till informerat samtycke och informerade val när det gäller undersökningar och behandlingar under graviditet och förlossning både utifrån FNs mänskliga rättigheter och utifrån svensk lagstiftning. Kvinnan har historiskt befunnit sig långt ned i den hierarkiska ordningen inom förlossningsvården. Det råder en riskkultur i det västerländska moderna samhället som även märks av i vården av gravida och födande kvinnor. Kvinnor genomgår många olika undersökningar och behandlingar under graviditet och förlossning av vilka några har oklar evidens. Barnmorskan har en viktig roll i att ge kvinnor möjlighet till informerat samtycke och informerade val när det gäller undersökningar och behandlingar under graviditet och förlossning. Det behövs mer kunskap om hur kvinnor i Sverige ges möjlighet till detta. Syftet med studien är att undersöka om kvinnor ges möjlighet till informerat samtycke och informerade val när det gäller undersökningar och behandlingar under graviditet och förlossning. Studien utfördes som en kvantitativ tvärsnittsstudie och datainsamlingen gjordes med hjälp av enkäter. Det insamlade materialet analyserades med både deskriptiv och analytisk statistik. Resultatet antyder att kvinnor inte ges möjlighet till informerat samtycke och informerade val utifrån begreppens rätta bemärkelse när det gäller ett flertal specifika undersökningar och behandlingar under graviditet och förlossning förutom när det gäller rutinultraljudsundersökningen. Kvinnor uppfattar dock att de ges möjlighet vara delaktiga i beslut rörande undersökningar och behandlingar överlag under graviditet och förlossning. Hierarkiska ordningar och riskkulturen som råder i förlossningsvården är tidigare påvisade faktorer som kan utgöra hinder för kvinnors möjligheter till informerat samtycke och informerade val under graviditet och förlossning. Med en vård baserad på ett patientperspektiv kan kvinnors ställning samt autonomi stärkas. För en hållbar utveckling är kvinnors möjligheter at t göra informerade val angående sin sexuella och reproduktiva hälsa avgörande. / Women have the right to informed consent and informed choice with regard to examinations and treatment during pregnancy and childbirth on the basis of the human rights conducted by The United Nations, and according to Swedish law. Women have historically been far down in the hierarchical order in the birthing care system. There is a risk culture in Western modern society that is also noticeable in the care of pregnant women and women giving birth. Women undergo a variety of examinations and treatments during pregnancy and childbirth, some of which have unclear evidence. The midwife has an important role to give women the opportunity for informed consent and informed choices regarding examinations and treatments during pregnancy and childbirth. There is a need for more knowledge about how women in Sweden are given the opportunity to do so. The aim of the study is to investigate whether women are given the opportunity for informed consent and informed choices with regard to examinations and treatments during pregnancy and childbirth. The study was conducted as a quantitative cross-sectional study and questionnaires were used for data collection. The collected data was analysed with both descriptive and analytical statistics. The results suggest that women are not given opportunities for informed consent and informed choices based on their true sense when it comes to several specific examinations and treatments during pregnancy and childbirth except for the routine ultrasound examination. Nevertheless do women perceive that they are given opportunities to participate in decision making regarding examinations and treatments in general during pregnancy and childbirth. Hierarchical schemes and risk culture that prevails in the birthing care system is earlier identified factors that may pose obstacles to women's opportunities for informed consent and informed choice during pregnancy and childbirth. Through a care based on a patient perspective, the status of women and women's autonomy would be strengthened. For sustainable development, women's opportunities to make informed choices about their sexual and reproductive health are crucial.

Do people’s attitudes towards female genital cutting (FGC) change after they migrate from a country where the practice is common, to one where it is not? Alongside increased levels of migration, this question is increasingly being raised. This thesis aimed to expand the understanding about attitudes towards FGC held by Somali men and women in Sweden, and thereby to identify potential factors that impede or facilitate the cessation of FGC. Cross-sectional questionnaire data were collected in four Swedish municipalities to assess attitudes to FGC. To further explore perceptions of FGC, as well as the circumcision of boys, semi-structured interviews and focus group discussions were conducted. Data were collected in 2015. The findings identified an overall widespread opposition to forms of FGC that cause anatomical change. A majority (78%) expressed an opposition to the continuation of all forms of FGC, with the odds of supporting FGC decreasing with increased years of residency in Sweden. An identified 18% reported a support for the continuation of pricking (FGC type IV). A support of pricking was linked with perceiving it as acceptable according to Islam, not a violation of children’s rights, and not causing long-term health complications. Pricking was not defined as a form of FGC by 32%. Most men described a preference to marry an uncircumcised woman (76%) or one who had had pricking (16%). How the individuals perceived the support of FGC in the Swedish Somali community corresponded well with their own approval of the practice. While there seemed to be a continuity regarding the Swedish Somalis’ core values of being a good Muslim, not inflicting harm, and upholding respectability, re-evaluation of how these are applied when it comes to circumcision of girls and boys was identified. This resulted in FGC being viewed as a practice that could be abandoned or adapted. Paradoxically, based on the same core values, the circumcision of boys was continuously perceived as an unquestionable required practice. Altogether, these results suggest that a shift in convention towards no FGC is taking place. However, the identified lack of consensus on practices regarded as FGC needs further attention.

El presente estudio analiza cómo la gestión de la comunicación es aplicada por un centro de salud privado en Lima, Perú, para promocionar la salud sexual y reproductiva, y de esta manera, generar cambios más saludables en los conocimientos, actitudes y prácticas de las personas. Se identificarán los medios utilizados para la planeación, gestión y evaluación de la campaña, y los factores que influyeron en su elección. También se analizará el desarrollo de la estrategia de comunicación planeada y la valoración de esta. Para realizar esta investigación con un diseño fenomenológico, y desde un paradigma interpretativo, la técnica de recolección de datos será la entrevista semiestructurada, que mantiene un equilibrio entre la estructura de una conversación guiada y la flexibilidad de poder utilizar un acercamiento creativo para aprovechar la entrevista desde distintos ángulos y enfoques que nos permitan conseguir resultados más fiables y certeros. El análisis de los resultados será temático. Bajo esta perspectiva, se identificarán a mayor detalle los patrones y los temas de mayor importancia en base al análisis de las entrevistas, obteniendo así una mejor comprensión del fenómeno en cuestión. / The present study analyzes how communication management is applied by a private health center in Lima-Peru to promote sexual and reproductive health and, also, contribute to generate healthier changes on people's knowledge, attitudes and practices. The resources applied for the planning and evaluation of the campaign will be identified, along with a justification for their use. The development of the planned communication strategy and its evaluation will also be analyzed. To carry out this research with a phenomenological design, and from an interpretive model, the data collection technique will be the semi-structured interview, which maintains a balance between the structure of a guided conversation and the flexibility to use a creative approach to take advantages of variety of angles and perspectives which will allow us to achieve more reliable and accurate results. The analysis of the results will be thematic. Through this perspective, it will be able to identify in greater detail the most important patterns and themes based on the analysis of interviews, thus getting a better understanding of the phenomenon in question. / Trabajo de investigación

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This study examines the accessibility and barriers that Polish immigrants face in public gynecological care in Sweden and explains their attitudes towards and frequency of gynecological visits. To understand attitudes of the research group, the study explores their knowledge about basic gynecological health topics such as Pap and HPV tests, HPV infections and vaccinations. Qualitative ethnographic methods were used in this research. Thirteen semi-structured interviews were conducted with 25 to 45-year old Polish women living in Stockholm, Sweden. Analysis was performed using descriptive and theoretical approaches. The results indicate several barriers to fully adapt to the Swedish healthcare system for Polish women. The barriers included the lack of understanding of how Swedish gynecological care works (division of specializations), problems in finding specialist care, an insufficient number of specialists, a lack of information in English or Polish, and a limited amount of knowledge among study participants about HPV tests and vaccinations. The adaptation of Polish immigrants to the Swedish system and their level of trust is influenced by their first experiences in Sweden, health literacy, experiences with the Polish private gynecological system, and the attitudes of partners and family with Swedish backgrounds or those who have long term experiences in Sweden.