Thesis (M.S.)--University of Michigan, 1990.

Le développement de cette étude part de l’observation des données de différentes sources au sujet de la fécondité des adolescentes de Basse-Californie (Mexique), qui a atteint un des plus hauts niveaux parmi les entités fédérées. Cet état est caractérisé par le fait que pratiquement la totalité de sa population se situe dans un territoire avec un contact quotidien potentiel avec la Californie aux Etats-Unis. D’autre part, il s’agit d’un état avec une forte immigration interne de population en provenance de plusieurs entités du pays. Un autre aspect qui caractérise à l’entité se réfère au comportement conservateur de ses autorités. La Basse-Californie est l’un des états qui a présenté des normes parmi les plus restrictives dans l’application des lois ainsi qu’un faible intérêt dans l’élaboration de stratégies qui cherchent à résoudre ce problème à partir des caractéristiques de l’entité. Dans ce contexte de forte immigration interne, d’influence potentielle des Etats-Unis et de gouvernements très conservateurs, la question centrale posée par cette étude renvoie aux niveaux de fécondité, aux variables qui dans une grande mesure la détermine en Basse-Californie, et aux causes potentielles de cette association en partant des théories qu’ont apportées différents auteurs. La méthodologie utilisée dans cette étude fut celle de l’enquête de probabilité au sein de ménages comprenant des femmes de 18 à 29 ans. L’enquête de Basse-Californie provient d’un projet dont l’initiative a surgi du Collège de la Frontière Nord en réponse à un appel d’offre de CONACYT, sous la direction de l’auteure du travail présenté ici. / This study was developed from the observation of data related to fertility of adolescents in Baja California, Mexico. This state presents high levels for this indicator compared to the rest of Mexico; most of its population lives close to the border with the United States and the state receives large numbers of immigrants from Southern Mexico. Governmental officials in Baja California hold conservative beliefs, therefore, regulations related to this topic are restrictive and there has been a low interest in designing strategies based on the characteristics of the state that could solve and prevent the high adolescent fertility. Within this context, high internal immigration, U.S. influence, conservative governments, the main question of this study deals with estimating the levels of fertility, which variables are determining it and finding out the relation between the fertility and its variables. The methodology used in this study was based on a probabilistic survey of women between 18 and 29 years old. This Baja California survey was the result of a project carried out at El Colegio de la Frontera Norte and financed by CONACYT, under my leadership.

L'objectif de notre première étude était d'identifier les déterminants génétiques et environnementaux du risque de maladie thromboembolique veineuse (MTEV) chez les femmes sous contraceptifs oraux combinés (COC). Après ajustement pour les facteurs confondants, les principaux déterminants environnementaux de la MTEV étaient le tabagisme (OR = 1,65) et un indice de masse corporelle supérieur à 35 kg.m2 (OR = 3,46). En outre, la thrombophilie héréditaire sévère (OR = 2,13) et les groupes sanguins non-O (OR = 1,98). Nous avons confirmé que l’histoire familiale au premier degré de MTEV prédit mal la thrombophilie. En conclusion, cette étude confirme l'influence du tabagisme et de l'obésité et pour la première fois l'impact du groupe sanguin ABO sur le risque de MTEV chez les femmes sous COC. Elle confirme également la faible sensibilité de l'histoire familiale de MTEV pour dépister les thrombophilies héréditaires.Le but de la deuxième étude était d'étudier, chez les utilisatrices de COC, l'impact des polymorphismes génétiques nouvellement identifiés par les études pangénomiques associés au risque de MTEV dans la population générale. Neuf polymorphismes situés sur les gènes KNG1, F11, F5, F2, PROCR, FGG, TSPAN15 et SLC44A2 ont été génotypés dans un échantillon de 766 cas et 464 témoins dans le cadre de l’étude PILGRIM. Seul le polymorphisme rs2289252 situé sur le F11 était significativement associé au risque de MTEV. La présence de l’allèle rs2289252-A du F11 était associée à un risque accru de MTEV (OR =1,6). En outre, la combinaison de l’allèle rs2289252-A et du groupe sanguin non-O, était associée à un risque d’OR de 4. / The aim of our first study was to identify the genetic and environmental determinants of venous thromboembolism (VTE) risk in a large sample of women using combined oral contraceptives (COC). A total of 968 women with a personal history of VTE during COC use were compared with 874 women under COC, but no personal history of VTE. After adjustment for confounding factors, the main environmental determinants of VTE were smoking odds ratio (OR = 1.65) and a body mass index greater than 35 kg.m-2 (OR = 3.46). In addition, severe hereditary thrombophilia (OR = 2.13) and non-O blood groups (OR = 1.98) have been shown to be important genetic risk factors for VTE under COC. First-degree family history of VTE predicts thrombophilia poorly. In conclusion, this study confirms the influence of smoking and obesity and for the first time the impact of ABO blood group on the risk of VTE in women under COC It also confirms the low sensitivity of the family history of VTE to detect hereditary thrombophilia. The purpose of the second study was to study, in COC users, the impact of newly identified genetic polymorphisms by genome-wide as associated with the risk of VTE in the general population. Nine polymorphisms on the KNG1, F11, F5, F2, PROCR, FGG, TSPAN15 and SLC44A2 genes were genotyped in a sample of 766 patients and 464 controls in the PILGRIM study. Only the rs2289252 polymorphism on the F11 was significantly associated with the risk of VTE. The presence of the F11 rs2289252-A allele was associated with an increased risk of VTE (OR = 1.6). In addition, the combination of the rs2289252-A allele and the non-O blood group was associated with an OR risk of 4.

Magister Curationis - MCur / It is not mandatory for the student to declare a pregnancy to her educational institution. It does however become more complicated for the student nurse, because she has to provide a health service while she is a student during her clinical placement. The researcher has noticed that student nurses do fall pregnant during their undergraduate studies at the University of the Western Cape. The researcher was unsure why this phenomenon is occurring amongst undergraduate nursing students. He identified the need to measure the level of knowledge of pregnancy prevention amongst undergraduate nurses, their level of utilization of such services and their attitudes towards falling pregnant during their studies. This study is of a quantitative nature whereby the researcher made use of a descriptive design. The method of data collection utilized was an anonymous self administered questionnaire form. The population under study was the registered undergraduate nursing students in 2008 at the University of the Western Cape. This population consisted of 1031 individuals. Their ethnic background represents the South African demography. An exhaustive sampling approach was used and 401 individuals gave consent to participate in the study. Through this research the researcher hypothysed and proved that the level of knowledge of contraception amongst undergraduate student nurses is indeed inadequate and that this low level of knowledge on the subject area leads to incorrect and inconsistent and non use of contraception in their own lives. / South Africa

Magister Curationis - MCur / Depo-Provera, an injectable contraceptive, is utilized by about 30% of married women in Malawi. Most women have reported their preference to use Depo-Provera due to its effectiveness in preventing pregnancy, reversibility and easy to use since it is given once at 12-weeks intervals. Despite the method having such advantages, it has menstrual effects, and one of the major concerns for women, particularly in Africa, is amenorrhea. In Malawi, 40% of Depo-Provera users report experiencing amenorrhea after one year of use. Despite the concern for amenorrhea, some women have continued using the method. Literature shows that there is limited information on women's experiences of amenorrhea following use of Depo-Provera. A descriptive phenomenological research design was used to explore and describe women’s experiences of amenorrhea following use of Depo-Provera in order to understand how women experience amenorrhea and give meaning to the experience. Data were collected through in-depth unstructured interviews with six women, who were selected using purposive sampling. The interviews were conducted in Tumbuka language. Data analysis was done using Colaizzi’s method of analyzing descriptive phenomenological data. Five themes and some sub-themes emerged from data analysis. The themes were: "Lack of knowledge on cause of amenorrhea", "Fear of pregnancy", "Misconceptions associated with Depo-Provera Induced Amenorrhea", "Lack of proper counseling on amenorrhea resulting from Depo-Provera use" and "Amenorrhea not perceived as a problem when midwives provide adequate information". The themes showed that women accessing family planning services from Chitipa district hospital were not provided with information on amenorrhea resulting from using Depo- Provera. Hence, they expressed fear when they experienced the side effect. Participants stated that they were afraid of becoming infertile after using the family planning method, getting pregnant as well as amenorrhea itself. Their intention to discontinue using the method was largely associated with negative rumors, beliefs and misconceptions. The conclusion of the study is that there is need for midwives to provide information on amenorrhea resulting from Depo-Provera use. This will assist clients to understand that amenorrhea could occur as a side effect, and hence improve continued utilization of the method.

Pour les femmes immigrées d’Afrique sub-Saharienne l’arrivée en France peut constituer une rupture dans leur trajectoire sexuelle, affective et reproductive. Si beaucoup ont déjà fait l’expérience d’une grossesse avant leur arrivée, un certain nombre n’aura pas encore débuté sa vie reproductive. Toutefois et pour les femmes qui le souhaitent, l’arrivée en France, et le changement du paysage contraceptif peut être l’occasion d’accéder à une contraception efficace ou bien de changer de méthode. En 2010, en France, sur l’ensemble de la population des femmes âgées entre 15-49 ans et en besoin de contraception, 78.5% déclarait utiliser une contraception médicale contre 22.9% en Afrique subsaharienne (tous pays confondus) pour les femmes de la même tranche d’âge. Par ailleurs, la population originaire d’Afrique subsaharienne est particulièrement touchée par le VIH/sida en Afrique mais aussi en France, où ils représentent le deuxième groupe le plus affecté.A partir de deux enquêtes, Parcours et Vespa 2, notre étude a visé à mettre en lumière les pratiques contraceptives et les éventuelles inégalités en matière de contraception dont les immigrées originaires d’Afrique subsaharienne feraient l’objet, afin de repérer les leviers d’une meilleure prise en charge de leur santé sexuelle et reproductive.Les résultats de cette thèse mettent en évidence que les femmes africaines immigrées se saisissent d'un système qui articule la promotion de la contraception, un dispositif d'accès facilitant et des pratiques médicales aboutissant à une forte adhésion à la contraception médicale efficace puisque la majorité des femmes déclare utiliser la pilule, l’implant et parfois le DIU. Ces résultats sont toutefois à moduler pour deux raisons. D’une part, lorsque les femmes vivent avec le VIH, (les femmes immigrées ou nées en France) utilisent très majoritairement le préservatif. D’autre part, le recours à l’implant est nettement plus marqué qu’en population générale ce qui doit nous inciter à poursuivre les études pour savoir jusqu'à quel point les méthodes en usage correspondent à un choix et conviennent aux besoins des femmes . / For immigrant women from sub-Saharan Africa, arriving in France may be a break in their sexual, emotional and reproductive trajectory. If many have already experienced pregnancy before arriving, a number will not have started their reproductive life. However, for women who wish so, the arrival in France and the change in the contraceptive landscape may be an opportunity to access effective contraception or to change the method. In 2010, in France, of the entire population of women between the ages of 15-49 and in need of contraception, 78.5% reported using medical contraception compared to 22.9% in sub-Saharan Africa (all countries combined) for women in the same age group. Moreover, the population from sub-Saharan Africa is particularly affected by HIV/AIDS in Africa but also in France, where they represent the second most affected group.Based on two surveys, Parcours and Vespa 2, our study aimed to highlight the contraceptive practices and possible inequalities in contraception that immigrant women from sub-Saharan Africa face, in order to identify improvements in their sexual and reproductive health care.The results of this thesis highlight that African immigrant women seize a system that articulates the sponsoring of contraception, easier access and medical practices resulting in a strong adherence to effective medical contraception since the majority of women report using the pill, the implant and sometimes the IUD. These results must however be adjusted for two reasons. On one hand, women living with HIV (immigrant women or women born in France) use condoms for the most part. On the other hand, the use of an implant is much more pervasive than in the general population which should encourage us to continue studying to what extent the methods in use correspond to a choice and are adapted to the needs of women.

This study emphasizes the impact of family planning program components on contraceptive prevalence in less industrialized countries. Building on Lapham and Mauldin's "Program Effort and Fertility Decline" framework and policy evaluation's theory, the author developed two models to examine the impact of family planning programs on contraceptive prevalence and fertility under the constraints of socioeconomic development and demand for family planning. The study employed path analysis and multiple regression on data from the 1982 program effort study in 94 less developed countries (LDCs) by Lapham and Mauldin and 98 LDCs of the 1989 program effort study by Mauldin and Ross. The results of data analyses for all data sets are consistent for the most part. Major findings are as follows: (1) A combination of program effort and socioeconomic development best explains the variation of contraceptive prevalence. (2) Among socioeconomic variables, female literacy exerts the strongest direct and indirect influences to increase contraceptive prevalence and indirect influence to decrease total fertility rate. (3) Christianity performs a significant role in reducing contraceptive prevalence. (4) Among program effort components, availability and accessibility for fertility-control supplies and services have the most influence on contraceptive prevalence. (5) When controlling for demand for family planning, female literacy and Christianity have expected and significant relationships with contraceptive prevalence. Availability and accessibility to fertility-control supplies and services exerts a positive and statistically significant impact on contraceptive prevalence. Demand for family planning has a positive and statistically significant effect on program variables, availability, and contraceptive prevalence. (6) There is a strong inverse relationship between contraceptive use and fertility. Demand for family planning, program effort, and socioeconomic development influence fertility through contraceptive prevalence. The findings of this study suggest that governments in LDCs should give priorities to increasing female education and availability of contraception to effectively reduce fertility.

BACKGROUND. Given the efficacy of most contraceptive options, it is of concern that most pregnancies in the USA are unplanned. Besides reducing the woman's and family's preparedness for parenting, unplanned pregnancies are at higher risk for inadequate prenatal care, perinatal morbidity, and significant postnatal problems. Little is known about the factors responsible for the high rates of unplanned pregnancy. METHODS. One hundred ten pregnant women were surveyed to examine factors relating contraception to unplanned pregnancy. RESULTS. Sixty-five percent of pregnancies were unplanned. There was a statistically significant association between having unplanned pregnancies and being single or divorced. Women who had planned their pregnancies tended to be more satisfied with contraceptives. In sexual encounters, women with unplanned pregnancies were more likely to use no contraception or to practice 'withdrawal' or use condoms rather than hormonal contraception; to be influenced by their partner regarding birth control use; and to forget to use contraception. CONCLUSIONS. All women of childbearing age who are sexually active can benefit from planning pregnancies. Counseling that accesses a woman's expectations regarding birth control, followed by a careful explanation of the side effects of a contraception choice, may reduce the rate of unplanned pregnancy. Counseling the male partner or sexually active men in contraceptive options may be equally important. Understanding factors that result in satisfaction with contraception may reduce unplanned pregnancies.

Objective: State medicaid programs provide access to effective contraception for people with lower incomes. This study examined contraception use and pregnancy among reproductive-age women enrolled in the South Carolina Medicaid, by eligibility program and socio-demographic sub-groups. Methods: A retrospective cohort of women aged 15–45 who were newly eligible for South Carolina Medicaid from 2012 to 2016 was examined. Log-binomial regression and average marginal effects assessed relationships between contraception use and pregnancies ending in live and non-live births. Contraception was categorized as permanent, long acting reversible contraception (LARC), short-acting hormonal contraception (SAC), or no contraceptive claims. Women with family planning or full-benefit medicaid coverage were included. Results: Approximately 11% of women used LARC methods, 41% used SAC methods, and 46% had no evidence of contraceptive claims. Method utilization varied by eligibility program, race/ethnicity and age. The likelihood of pregnancy was lower among SAC users and lowest among LARC users compared to women with no evidence of contraception across all three programs (family planning APR = 0.44; 95% CI 0.41–0.49 and APR = 0.13, 95% CI 0.10–0.17; Low income families APR = 0.82; 95% CI 0.77–0.88 and APR = 0.33, 95% CI 0.28–0.38; Partners for Healthy Children APR = 0.72; 95% CI 0.68–0.77 and APR = 0.35, 95% CI 0.30–0.43, respectively). Non-Hispanic Black and Hispanic teens were less likely to experience a pregnancy than non-Hispanic white teens. Conclusions for Practice: The likelihood of pregnancy was lower among women using SAC methods and markedly lower among women using LARC. Variation in contraceptive use among racial/ethnic groups was noted despite Medicaid coverage. As new policies and initiatives emerge, these findings provide important context for understanding the role of Medicaid programs in reducing financial barriers to contraceptive services and ensuring access to effective contraception, while fostering reproductive health autonomy among women.

Modern methods of contraception are freely available in Albania, yet contraceptive prevalence among Albanians is relatively low (11%). Abortion on the other hand has long been the mainstay of family planning in the country. Emergency contraception is not very popular in Albania either, even though two different levonorgestrel-only EC pills (NorLevo® and Postinor®) are widely available in Albanian pharmacies. This study aimed to investigate potential factors that influence women’s choices of contraception. In 2016, we conducted a multi-method qualitative study with women and service providers in Albania. Women were invited to report their knowledge of, attitudes toward, and practices surrounding contraception in an online survey. Also, we conducted in-depth semi-structured interviews with key informants to better understand the current reproductive health landscape in the country. Additionally, we conducted structured interviews with pharmacists in Tirana to assess their training and practices with regard to different available contraceptive methods. Misinformation, lack of awareness, fear of judgement and embarrassment, and lack of infrastructure are the strongest influencers of women’s choice of contraception in Albania. Training of health service providers, as well as development of materials for distribution are warranted to improve knowledge and uptake of contraception among women.