Using multiple regression analysis, this study analyzes the impact of state-level adolescent reproductive health statutes on rates of teenage pregnancy, birth and abortion rates. This study also analyzes the impact that adolescent reproductive health policy outputs have had on teenage pregnancy outcomes between 1992 and 2008, and the disparate impact of policies on minority teens. While some preventive adolescent reproductive health policies are found to impact teen pregnancy outcomes, most research findings pertain to the impact of abortion policy. Restrictions on minors' access to confidential prenatal care are associated with reduced rates of teen abortion while restricting access to contraceptive services is associated with increases in teen abortion. Surprisingly, states with more family planning program spending are found to have been less effective in reducing rates of teen pregnancy and births between 1992 and 2008. Abortion restrictions are found to decrease rates of teen abortion and increase rates of teen birth. Mandated parental involvement in minors' abortions is found to increase rates of teen birth and contributed to a slower rate of decline in teen abortion between 1992 and 2008. This study indicates disparate impact of both preventive adolescent reproductive health policies and restrictive abortion policies. Restrictive abortion statutes were found to have an exceptionally strong positive effect on rates of Black teen birth, with a moderate impact on Hispanic teen birth and no impact on White teen birth.

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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))

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))

La baisse de plus en plus marquée de l’âge au premier rapport sexuel et l’augmentation de l’âge au premier mariage impliquent une durée plus longue d’exposition au risque des grossesses prénuptiales et aux infections sexuellement transmissibles incluant le VIH/sida. C’est pourquoi des interventions ont été mises en place en vue de protéger la santé des adolescents et jeunes. L’Observatoire de Population en Épidémiologie Socio-Clinique (POSE) conçu et mis sur pied au Cameroun depuis 1995, a fait de la santé des adolescents et jeunes une de ses priorités de santé publique en Afrique à travers le programme de promotion de la santé reproductive des adolescents et jeunes au Cameroun (CAREH). Le Programme CAREH mène des activités d’intervention dans la préfecture de Bandjoun depuis juillet 2000, et dans plusieurs autres régions du Cameroun depuis 2003. Cette thèse vise à évaluer certains aspects de cette intervention, en examinant dans quelle mesure entre 2000 et 2002, les activités d’intervention menées auraient contribué : 1) au report à plus tard du premier rapport sexuel chez les adolescents de 10 à 20 ans ; 2) à la prévention des grossesses non désirées chez les jeunes de 10 à 29 ans ; et 3) à la prévention de l’infection à VIH chez les jeunes de 10 à 29 ans. Les données proviennent de l’Enquête sur la Famille et la Santé au Cameroun (EFSC), menée à Bandjoun en 2002. Un devis post-intervention a été utilisé après stratification des adolescents et jeunes en quatre groupes à savoir : jeunes exposés à l’intervention en milieu communautaire, jeunes exposés à l’intervention en milieu scolaire, jeunes non scolarisés non-exposés à l’intervention et jeunes scolarisés non-exposés à l’intervention. Les analyses descriptives et les analyses multivariées utilisant la régression logistique ont été utilisées pour examiner les associations présumées entre les variables d’intervention et les variables dépendantes considérées par rapport aux hypothèses de recherche émises. Nos analyses suggèrent que les adolescents scolarisés qui n’avaient pas déclaré avoir été exposés à l’intervention (RC = 1,973 ; IC =1,195-3,260) sont plus portés à avoir une perception négative de la sexualité prémaritale, que les adolescents non scolarisés n’ayant pas déclaré avoir été exposés aux activités d’intervention. Il n’y avait cependant pas de report significatif du premier rapport sexuel dans les groupes d’adolescents exposés à l’intervention par rapport à ceux non-exposés. Les connaissances sur la prévention des grossesses sont significativement plus élevées chez les jeunes scolarisés non-exposés (RC=1,953; IC=1,452 – 2,627), jeunes exposés à l’intervention en milieu communautaire (RC = 3,074 ; IC = 2,157 - 4,382) et les jeunes exposés à l’intervention en milieu scolaire (RC = 4,962 ; IC = 3,367 - 7,311) que chez les jeunes non scolarisés n’ayant pas déclaré avoir été exposés aux activités d’intervention. Il n’y a aucune différence statistiquement significative entre ces différents groupes quant à l’utilisation de la contraception moderne. La discussion sur la prévention des grossesses ou l’utilisation de la contraception avec un formateur était significativement associée à une amélioration des connaissances en prévention de grossesses chez les jeunes exposés à l’intervention en milieu scolaire (RC = 1,549 ; IC = 1,056 – 2,272), comparativement à leurs camarades exposés aux activités d’intervention en milieu communautaire sans avoir bénéficié d’une telle discussion. Les jeunes exposés à l’intervention en milieu communautaire (RC = 2,106 ; IC = 1,514 – 2,930) et ceux exposés l’intervention en milieu scolaire (RC = 3,117 ; IC = 2,192 – 4,433) connaissent mieux les modes de prévention de l’infection à VIH que les jeunes scolarisés mais n’ayant pas été exposés aux activités d’intervention. Il n’y avait toutefois pas de différences entre les groupes quant à l’utilisation du condom. Ces conclusions sont interprétables dans les limites des données disponibles. En effet, il n’a pas été possible de déterminer les niveaux de connaissances en prévention de grossesses ou du VIH avant l’exposition des jeunes à l’intervention. Ainsi, chez les jeunes exposés en milieu communautaire ou scolaire, on ne peut savoir quel aurait été leur niveau de connaissance en l’absence de l’intervention. Toutefois, il est très probable que l’intervention ait eu plus d’effets bénéfiques sur l’amélioration des connaissances que des comportements. / Early sexual initiation and delayed marriage are concurrently happening in most environments in Africa where traditionally early marriage and sexual initiation within marital union were more prevalent. This lengthens the time of exposure of young people to the risk of premarital sex and unwanted pregnancies as well as sexually transmitted infections including HIV/AIDS. Hence, several interventions have been carried out to promote the sexual and reproductive health of adolescents and young people. The Population Observatory in Socio-Clinical Epidemiology (POSE) designed and implemented since 1995 in Cameroon, had targeted the reproductive health promotion of adolescents and young people as one of its priorities, through the Cameroon Adolescent and Youth Reproductive Health Promotion Program (CAREH). The CAREH Program has been carrying out a series of intervention activities in the prefecture of Bandjoun since July 2000 and many other parts of Cameroon since 2003. This thesis evaluates some aspects of this intervention by examining the extent to which the intervention activities undertaken between 2000 and 2002 have contributed to: 1) delaying first sexual intercourse among adolescents aged 10 to 20 years, 2) preventing unwanted pregnancies among young people aged 10 to 29 years, and 3) preventing HIV infection among young people aged 10 to 29 years. Data came from the 2002 Cameroon Family and Health Surveys (CFHS). A post-test design was used which divided adolescents and youth into four intervention groups (out-of-school youth unexposed to the intervention, young people enrolled in schools and unexposed to the intervention, young people exposed to the intervention in the community and young people exposed to the intervention in school settings). Descriptive analyses and multivariate logistic regression were used to assess the possible associations between intervention and outcomes variables, given the enunciated research hypotheses. Adolescents attending school who reported no exposure to the intervention (OR = 1.973; CI = 1.195 to 3.260) were more likely to have a negative perception of premarital sex than out-of-school and unexposed adolescents. However, there were no significant differences in delaying the first sexual intercourse among adolescents exposed to the intervention compared to those not exposed. Knowledge about the prevention of pregnancy was significantly higher among unexposed students (OR = 1.953, CI = 1.452-2.627), youth exposed to the intervention in the community (OR = 3.074; CI = 2.157-4.382) and youth exposed to the intervention in school (OR = 4.962, CI = 3.367 to 7.311) than among those not exposed and not in school. No statistically significant difference was found between these groups regarding the use of modern contraception. The discussion about pregnancy prevention or contraceptive use led by a CAREH peer-educator significantly improved knowledge about pregnancy prevention for youth exposed to the intervention in school compared to their peers exposed in community where such discussion did not occur (OR = 1.549, CI = 1.056 to 2.272). Young people exposed to the intervention in community settings (OR = 2.106, CI = 1.514-2.930) and those exposed in school settings (OR = 3.117, CI = 2.192-4.433) significantly improved their knowledge about HIV prevention more than out-of-school youth unexposed to the intervention. Nevertheless, there were no significant differences between groups regarding the use of condom. These findings should be interpreted within the limits of available data. Indeed, it was not possible to determine the level of knowledge about pregnancy prevention or HIV prevention among young people exposed to the intervention before hand. Therefore, it is impossible to know what level of knowledge young people exposed to the intervention would have had in the absence of the intervention. However, given the results comparing the four stratified groups, it is likely that the intervention had more beneficial effects on improving knowledge than behaviours.

Title: The effect of menstrual cycle phases on muscle tone Goals and methods: The aim of this thesis is to prove the effect of menstrual cycle phases and participating hormons on the viscoelastic properties of the sceletal calf muscle via the non-invasive myotonometer device. The research part of this thesis is a pilot study in which participated seven female probands aged inbetween 24 to 28. Each proband participated in four weekly tests. Only probands who had not used hormonal contraception for at least six months were selected. Results: The results of the tests are represented in graphs picturing parts of curves representing the force caused by the tip of the myotonometer. The muscle soleus tension is changing throughout the menstrual cycle but its impossible to eliminate other endogenous and exogenous factors. The measured relative values of muscle tension are different for each proband. The menstrual phase has the highest average value of muscle tension. However, it is not possible to make a generally valid conclusion. Key words: Menstrual cycle, menstrual phase, muscle tone, calf muscle, biomechanical properties, myotonometry, contraception 5

Title: The effect of menstrual cycle phases on muscle tone Goals and methods: The aim of this thesis is to prove the effect of menstrual cycle phases and participating hormons on the viscoelastic properties of the sceletal calf muscle via the non-invasive myotonometer device. The experimental part of this thesis is a pilot study in which participated seven female probands aged inbetween 24 to 28. Each proband participated in four weekly tests. Only probands who had not used hormonal contraception for at least six months were selected. Results: The results of the tests are represented in graphs picturing parts of curves representing the force caused by the tip of the myotonometer. The muscle soleus tension is changing throughout the menstrual cycle but its impossible to eliminate other endogenous and exogenous factors. The measured relative values of muscle tension are different for each proband. The menstrual phase has the highest average value of muscle tension. It is not possible to make a generally valid conclusion. Key words: Menstrual cycle, menstrual phase, muscle tone, calf muscle, biomechanical properties, myotonometry, contraception

Magister Philosophiae - MPhil / The purpose of this research is to study the effect of different demographic and socio economic factors on the contraceptive use among currently married women of age 15-49 in the two regions of Ethiopia, Amhara (17,214,056) and Oromiya (27,158,471). Data are obtained from the 2005 Ethiopian Demographic and Health Survey (EDHS). Information on contraceptive use was provided by current use 1334 (14.7), future use 4017 (52.0), unmet need for spacing 1817 (20.0) and limiting 1249 (13.3) currently married women aged 15-49 interviewed in the 2005 Ethiopian Demographic and Health Survey (EDHS). / South Africa

O presente estudo teve por objetivo investigar as práticas e as representações ligadas à vida reprodutiva entre jovens universitários da Universidade de São Paulo (USP), especialmente aquelas dirigidas à contracepção e à prevenção de doenças sexualmente transmissíveis, no âmbito das relações heterossexuais.A pesquisa foi dividida em duas fases. Na primeira, foi elaborada uma amostra representativa dos estudantes matriculados em cursos de graduação da USP, na Cidade de São Paulo, no ano de 2000, e foram entrevistados 952 alunos e alunas com idade entre 17 e 24 anos. Na segunda, foram gravadas entrevistas em profundidade com 33 estudantes que se ofereceram voluntariamente para continuar participando da pesquisa. O uso do condom é freqüente entre os estudantes universitários, principalmente na primeira relação sexual. No entanto, o uso desse método apresenta descontinuidades. Além da primeira relação sexual, o condom é usado especialmente nas relações casuais e no início dos relacionamentos sexuais com um parceiro ou uma parceira novos. Os jovens negligenciam o condom no contexto do namoro, tendendo a substituí-lo pela pílula. A contracepção é cercada por descuidos, erros e esquecimentos e os estudantes mencionam que utilizam métodos de baixa eficácia, como o coito interrompido e a abstinência periódica para regular a fecundidade. Os estudantes manifestam um forte desejo de adiar a fecundidade, mas o uso inadequado de métodos contraceptivos e o recurso aos métodos de baixa eficácia podem levar a uma gestação não planejada. 77% do total de entrevistados afirmou que gostaria de ter até dois filhos e a idade ideal para ter o primeiro filho seria próxima aos 30 anos. Somente 4% dos entrevistados e entrevistadas referiram ter passado por uma gestação. Apesar do pequeno número de gestações referidas, o aborto provocado foi a forma de finalização de uma alta proporção dessas gestações. Os resultados da pesquisa indicam que uma complexa rede de representações simbólicas subsidia as condutas diante da contracepção e da saúde reprodutiva. Essas representações constróem o sentido da sexualidade, classificando-a, definindo regras e obrigações segundo cada situação e orientando práticas. Questões de gênero pontuam os discursos sobre os temas tratados. As diferentes concepções sobre o "ficar" e o namorar, a opção pelo método contraceptivo, as representações sobre as responsabilidades do homem e da mulher frente à contracepção e, especialmente, os discursos sobre o aborto revelam a importância que os diferenciais de gênero assumem perante a construção do sentido da sexualidade e da vida reprodutiva. Questões de gênero também marcam a busca de orientação médica, no âmbito da saúde reprodutiva. A consulta médica é restrita ao grupo das mulheres e o método mais indicado é a pílula, embora trate-se de jovens mulheres solteiras que estão iniciando a sua vida sexual. Observa-se, por sua vez, que os homens jovens estão totalmente alijados do sistema de saúde, ainda que se trate de um grupo com alta escolaridade que recorre à medicina privada. O estudo indica que os diferenciais de gênero estão presentes desde o processo de rotulações e significações que dão sentido a vivência da sexualidade e da regulação da fecundidade até o âmbito das políticas públicas voltadas para a saúde reprodutiva dos jovens, revelando uma importante lacuna nos serviços de saúde que necessita ser contemplada por políticas públicas capazes de promover a eqüidade de gênero na atenção à saúde reprodutiva e de incluir os jovens do sexo masculino nos serviços de saúde. / The present study aimed at investigating the practices and representations linked to the reproductive life of university youths from the Universidade São Paulo (USP) especially those geared at contraception and prevention of STD’s in the scope of heterosexual relations. The project was divided into two phases. In the first a representative sample of 952 male and female students between 17 and 24 years old enrolled in under-graduate courses at USP in the city of São Paulo in 2000 was elaborated. In the second phase in-depth-interviews with 33 students that volunteered to continue take part of the research were recorded. The use of condom is frequent among university students mainly at the first sexual intercourse. However, this method presents discontinuity. Beyond the first sexual intercourse it is used especially in the casual relationships and in the beginning of new sexual relationships with a new partner. Youth neglect the condom in the dating context tending to replace it for the pill. Contraception is surrounded by carelessness, mistakes and neglect and the students mention the use of low efficacy methods such as interrupted copulation and periodic abstinence for fertility control. The students revealed strong will to delay fertility but the inadequate use of contraceptive methods and use of low efficacy methods may lead to an unplanned pregnancy. 77% of the interviewees state that they would like to have up to two children and that the ideal age for the first child would around 30. Only 4% of the interviewees referred having had a gestation. Despite the small number of pregnancies referred the provoked abortion represented a high proportion of pregnancy termination. The results of the survey indicate that a complex network of symbolic representations accounts for the conducts in terms of contraception and reproductive health. These representations construct the sense of sexuality, classifying it, defining rules and obligations according to each situation and guiding practices. Gender issues mark the discourses on the themes discussed. The different conceptions about noncommitted dating and dating proper, the option for the contraceptive method, representations on the male and female responsibilities with reference to contraception and especially the discourses on abortion reveal the importance the gender differentials possess in face of the construction of meaning of sexuality and reproductive life. Gender issues influence the search for medical guidance in the context of reproductive health. Medical consultation is restricted to the female group and the most prescribed contraceptive method is the pill in spite of the fact that they are young single women in the beginning of their sexual life. On the other hand it was observed that young men are totally cast out of the health system notwithstanding the fact that this is a group with high level education with access to private medicine. The study indicates that the gender differentials are present from the process of labeling and signification that attribute meaning to the experiencing of sexuality and the regulation of fertility to the scope of public policies capable of promoting gender equity in the attention to reproductive health of youth. That reveals an important gap in the health services that must be addressed by gender equity promoting public policies that also inscribe male youth in the health services.