Every year about half a million women die from complications of pregnancy, parturition and puerperium, most of which are preventable. The purpose of this thesis was to chart the distribution and decline in maternal mortality in Sweden between 1751 and 1980, and furthermore to characterize positive (predisposing) factors and negative (protective) factors of maternal mortality. Maternal mortality declined from 900 to 6.6 per 100,000 live births in these 230 years. Maternal deaths accounted for 10070 of all female deaths in the reproductive ages between 1781 and 1785, but only 0.2.0/0 between 1976 and 1980. However, in the 19th century 40-450/0 of the female deaths in the most active childbearing ages were maternal deaths. The children left motherless had an extremely high mortality. Indirect maternal deaths and puerperal sepsis accounted for the bulk of maternal deaths in the rural areas. Only a minority of maternal deaths occurred in lying-in hospitals. Midwifery services in rural areas and antiseptic techniques were most effective in preventing maternal deaths during the late 19th century. The changing distribution ofage and parity amongst the parturients had a definite impact on the mortality decline, enhanced by time, contributing to 500/0 of the mortality decline over the last 15 years. The expontential decline of cause-specific mortality and case fatality rates during the last 40 years is furthermore explained by the emergence ofmodern medicine - antibiotics, antenatal and obstetric care. The earlier serious problem of illegal abortions was eradicated by legislation and changes in hospital practice. The maternal mortality decline has levelled out during the 1970s, the relative importance of embolism as a cause of death is increasing. Advanced age and intercurrent disease are the most difficult risk factors to overcome. To conclude, this study indicates that the reason why maternal mortality has declined faster than otherhealth indices is that the major part of the maternal deaths can be prevented by medical technology, including family planning, antenatal and obstetric care. This experience should be of interest to developing countries where high rates of maternal mortality prevails.

In an effort to connect women’s spiritual development to the general call for professors to reconnect significantly with their students, this dissertation argues that expressive writing should remain a staple of the composition curriculum. It suggests that the uses of expressive writing should be expanded and explored by students and professors of composition and that each should become familiar with the link between writing and emotional wellness. In cancer centers, schools of medicine, and pregnancy care centers, writing is being used as a tool of therapy. More than just a technique for helping people cope with the stresses of loss, pain, and abuse, teaching personal writing techniques enables writers to transfer their skill in writing narratives to other forms of writing, including the more traditional academic essay. By presenting interdisciplinary blending of composition and performance studies, the discussion introduces contemporary tools of writing that engage digital environments and digital storytelling techniques already familiar to students. An important highlight of the research, that allowing students to treat personal themes in the writing classroom boosts students’ overall academic performance, is a discussion relevant to professors outside of the English department. Spurred by the public health calls for intervention in the HIV and HPV spread on minority, tribal, and HBCU campuses, the essay also considers the appropriateness of offering the Life-Support Class (a mainstay of Pregnancy Care Centers) in campus clinics. The subject of emotion is treated in the essay in relation to women’s relationships on campus and the evasion and stigmatization of emotion among professors in the academic setting. Further, the essay highlights research which suggests that a fear of feminist retaliation interferes with campus psychologists’ recommendations for the best outcomes for sexual health. This dissertation follows the trend of feminist research methodology by explicitly exposing the author’s hopes and goals, which connect women’s spiritual formation to expressive writing.

Background: Preconception care (PCC) is highly recommended evidence-based intervention to optimize women’s health in particular and in so doing reduce the incidences of adverse pregnancy outcomes (APO). PCC targets modification of risk factors to APO occurring before and just at early weeks of conception. Nevertheless, in Ethiopia, the need to implement PCC as part of the continuums of the comprehensive Maternal, Neonatal and Child Health Care services is not yet studied. Purpose/Aim of the study: This study aimed to develop a guideline to assist the incorporation of PCC in Ethiopian health system thereby reduce the highly incident APOs in the country, which is the purpose of the study. Methodology: This study applied the explanatory sequential mixed method to determine the determinants to the non-implementation PCC in Ethiopia. In addition, a policy document analysis was conducted to identify the existence of policy guiding the implementation of PCC in Ethiopia. Finally, the study applied a Delphi technique to increase the utility and acceptance of the guideline developed. The study was guided by a theory based framework called a Framework for Determinants of Innovation Processes (FDOIP). RESULT: Nearly all (84.7%) of the healthcare providers (HCPs) never ever practiced PCC. Even among those who ever practiced, the majority (74%), practiced it poorly. More than two third (68.6%) had poor PCC knowledge. HCP’s with good PCC knowledge had likely hood of practicing PCC by four times greater than those with poor PCC knowledge (AOR=4.4, 95% CI: 2.5-7.6). The policy document analysis identified the absence of policy guiding the practice of PCC in Ethiopia. The HCP’s curriculums also didn’t include PCC. The determinants to non-implementation of PCC, as perceived by the qualitative study participants include absence of national PCC policy , absence of PCC guideline, lack of institutional PCC plan, presence of other competing demand, lack of laboratory facilities and setup, lack of accountable body, absence of Individual or organization introduced PCC to the country, absence of trained manpower on PCC, absence of known expert in PCC, Poor public awareness about preconception health and PCC, Unplanned Pregnancy and poor health seeking behaviour. CONCLUSION The study revealed the absence of a standard and complete PCC practices by the HCPs. Nearly all HCPs never ever implement PCC. Even those very few practitioners were found practicing PCC poorly that is in a substandard, incidental, and in an inconsistent way. There is no formal policy document guiding the implementation of in Ethiopia. The HCPs training curriculum didn’t include PCC. The guideline developed base on the study findings of the study recommended to incorporating PCC in Ethiopia health system. / Health Studies / D. Litt. et Phil. (Health Studies)

Introduction: Evidences indicate that human immuno-deficiency virus (HIV) and diabetes (DM) impact pregnancy outcomes but no experience on the integrated service delivery of HIV, DM and pregnancy care. This study explored the domains and levels of integration among DM, HIV and pregnancy care to prepare a service delivery model in Ethiopia. Methods: A sequential exploratory mixed method and the integration theoretical framework guided the study. An exploratory qualitative phase used focused group discussion, in-depth interview and observation to explore the level of integration and to refine a questionnaire for the quantitative phase. The data were transcribed and coded for theme-based analysis. The descriptive quantitative phase described HIV, DM and pregnancy care services, and determined the burden of DM among HIV patients and the prevalence of pregnancy and pregnancy outcomes. Data was analysed using Epi-info. The findings were triangulated, discussed and interpreted. Results: Seven themes were generated: joint plan, shared budget, monitoring system, structural location, the need of policy guide, the practice of integrated service delivery and suggested integration approaches. A coordinated HIV and pregnancy care services were noted. There was a linkage between diabetes and HIV, and diabetes and pregnancy care. The 1.5% of diabetes among HIV, the low number of pregnancies per a mother in diabetes (1.8) and HIV (1.3); the high adverse pregnancy outcomes among HIV (13.4% abortion, 12.4% low birth weight (LBW), 3.5% pre-term birth, 2.1% congenital malformation) and diabetes (3.2% big baby, 3.2% LBW, 3.1% Cesarean-section); the respective absent and low (16.2%) diabetes screening service at anti-natal and HIV clinics, the absent pregnancy care service for diabetic females justified the development of the tripartite integrated service delivery model of diabetes, HIV and pregnancy care. Conclusions: The model suggests active diabetes screening, evaluation and treatment at HIV and antenatal clinics. It considers the coordination between non-communicable diseases (NCD), HIV and maternal health units. Pregnancy care could be coordinated at HIV and NCD units. Full integration can be practiced between HIV and pregnancy care units. Preparing policy guide, building the capacity of health providers, advocating and piloting the model may be prioritized before the implementation of the model. / Health Studies / D. Litt. et Phil. (Health Studies)