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Yes / Pregnant asylum-seeking and refugee women are a particularly vulnerable group in society, who may be possibly living alone in poverty in inappropriate accommodation (Dunne, 2007) and experiencing hostile attitudes (Hynes and sale, 2010). They may have poor physical and mental health, placing them at an increased risk of poor pregnancy outcomes (National Institute for Health and Care Excellence (NICE), 2010). Despite this, they are less likely to attend for timely maternity care. This article discusses the evaluation to date of an ongoing befriending project located in Northern england, targeting pregnant asylum-seeking and refugee women and helping to address difficulties that they may face. Volunteer befrienders, who themselves are asylum-seeking and refugee mothers, receive training to provide support and guidance to clients. Preliminary data suggest that befriending has advantages for both client and volunteer: clients appear to develop a trusting relationship with their befriender which facilitates self-confidence and helps overcome social isolation; and the volunteers feel that they are undertaking a worthwhile role and often move onto paid employment. Befriending may be a useful resource for midwives and ultimately improve pregnancy outcomes for asylum-seeking and refugee women.

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This thesis explores theories of postfeminism and discourses of “can-do” and “at-risk” girlhood as they are enacted in MTV’s teen pregnancy franchise, which I define as including 16 and Pregnant, Teen Mom, and Teen Mom 2. Specifically, this project examines how MTV frames the young mothers featured across this franchise as what I label “postfeminist failures.” Within its teen pregnancy programming, MTV exploits the shortcomings of the featured teen mothers. These failures include broken relationships, prison sentences, and subsequent pregnancy scares and pregnancies. Furthermore, these failures all stem from the teen mothers’ initial failure to adequately manage her sexuality, as evidenced by getting pregnant at age sixteen. These failures constitute much of the plot of MTV’s docu-dramatic series and have also spilled over into paratexts related to MTV’s franchise. I contest in this thesis that the rhetoric of postfeminist failure, first articulated and exploited in 16 and Pregnant, Teen Mom, and Teen Mom 2, is then reproduced in the franchise’s paratextual materials. These paratexts range from reunion shows hosted by Dr. Drew Pinsky to tabloid magazine coverage. I also interrogate the celebrity status of MTV’s featured teen mothers, especially those on Teen Mom and Teen Mom 2, and problematize publicity and fame rooted in the failure of these girls to adhere to normative standards of postfeminist womanhood. MTV’s teen pregnancy franchise is categorized as reality television, a genre derided by many scholars as lowbrow and devoid of substance. In order to combat these assumptions about reality television, particularly because this teen pregnancy franchise is promoted as educational for its audience, MTV has fostered strategic partnerships with The Kaiser Family Foundation’s “It’s Your (Sex) Life Campaign” and The National Campaign to Prevent Teen and Unplanned Pregnancy. Through these partnerships, MTV has infused its reality content with pathways to information-rich websites about contraceptives and pregnancy prevention sponsored by each non-profit. Through analyzing these partnerships and cultural discourses surrounding teen pregnancy, I question the assumption by many proponents and critics of the franchise that the content must either be educational for its viewers or purely entertaining programming. / text

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STUDY OBJECTIVES: We sought to evaluate the construct validity and factor structure of the Spanish-language version of the Pittsburgh Sleep Quality Index (PSQI) among pregnant Peruvian women. METHODS: A cohort of 642 women were interviewed at ≤ 16 weeks of gestation. During interview, we ascertained information about lifestyles, demographics, sleep characteristics, and mood symptoms. Stress induced sleep disturbance, depressive symptoms, and anxiety symptoms were evaluated using the Ford Insomnia Response to Stress Test (FIRST), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) assessment scales, respectively. Consistency indices, exploratory and confirmatory factor analyses, correlations, and logistic regressions were used. RESULTS: Both exploratory and confirmatory factor analyses indicated a three-factor solution: sleep quality, sleep efficiency, and sleep medication. We observed significantly positive correlations of the PSQI with the FIRST (0.42), the PHQ-9 (0.49), and the GAD-7 (0.46). Poor sleepers (PSQI global score > 5) had significantly increased odds of experiencing stress-induced sleep disturbance (odds ratio, OR = 3.57; 95% CI: 2.40, 5.31), depression (OR = 5.48; 95% CI: 3.58, 8.37), and generalized anxiety disorder (OR = 4.57; 95% CI: 3.08, 6.76). CONCLUSION: The Spanish-language version of the PSQI instrument was found to have good construct validity among pregnant Peruvian women. Consistent with some other studies, the PSQI was found to have a three-factor structure. Further assessment and validation studies are needed to determine whether the three, factor-specific scoring of the PSQI is favored over the PSQI global score in diverse populations.

MPH, Maternal and Child Health, Faculty of Health Sciences, University of the Witwatersrand / Due to the high prevalence of HIV in South Africa, all pregnant women are offered an HIV test as part of the package of services offered during ante natal care (ANC). All women who present to an ANC clinic for the first time for that given pregnancy are given group talks about HIV and the availability of services to protect their children from HIV through Prevention of Mother to Child Transmission (PMTCT) services. Following these group discussions, all the women are then counselled on a one on one basis and are offered an HIV test. Women who decide not to take the test can opt out of testing at this stage, those who do go ahead and test are also offered post test counselling after which their test result is given to them. All HIV tests are conducted using rapid HIV test kits which make results known within 15 minutes, the results are given to the women on the same day of testing. Women whose CD4 count is below the antiretroviral treatment(ART) initiation threshold† are fast tracked onto ART , those whose CD4 is above the threshold should then be referred to other services which can help them maintain their health.1 These services are part of the Comprehensive Care, Management and Treatment (CCMT) approach. They include: CD4 count monitoring; treatment for opportunist infections; social workers, and support groups for psychosocial support.2 For purposes of this study, these services are collectively referred to as Wellness services. Thus PMTCT should serve as a gateway to either ART or Wellness services. This study therefore sought to describe the linkages between PMTCT, ART and Wellness by reviewing service utilisation levels and referral systems at sampled health facilities in Soweto. Data for this study were collected via a cross sectional record review of PMTCT registers and an ART initiation register at sampled health facilities. PMTCT registers were reviewed for the period January to March 2008 to determine what service had been given to pregnant women who accessed PMTCT services for the first time during that period † In his speech on World AIDS Day (December 1st 2009) President Jacob Zuma announced that CD4 count threshold for treatment initiation will be raised from 200 to 350 as of April 2010. 0707048E 2 and which follow on services they had been referred to. ART registers were reviewed for the period January to August 2008 to determine which of the pregnant women who had been referred to ART from the PMTCT service points at the sampled clinics accessed the service. Key informant interviews were also conducted with staff at PMTCT, ANC, ART and voluntary counselling and testing (VCT) service points at the sampled facilities. Descriptive statistics were run using SPSS version 17.0, comparisons were done using OpenEpi and key informant interview data were thematically analysed using Atlas TI version 5.2.0. Records at the PMTCT clinics showed that of the 1350 women who attended ANC clinics at the sampled facilities between January and March 2008, all but one agreed to test for HIV. Twenty-nice percent (388) tested positive for HIV. Of these 388 HIV positive women, 20% (77 women) had CD4 counts below 200 and were therefore eligible for initiation of ART. Review of records at the ART clinic showed that only 23% (n = 18, N = 77) of all ART eligible women had accessed the service. Review of the PMTCT register also showed that a significant proportion, 37% (n = 144, N =388), of women who tested HIV positive did not return to the clinics for their CD4 count results. These women therefore missed opportunities to access other follow on services to which they could have been referred and possibly ART as 31% (24 women) of these women were also eligible for ART. Review of records at Wellness services was not possible as no indications were made in the PMTCT registers of follow on services other than ART to which HIV positive women were referred. Thus the greater majority of women who were eligible for ART (77% of the 77 eligible women) did not access ART which they required to help them maintain their physical wellbeing. These women missed the opportunity to access holistic health care services, it is not known if they accessed ART services at other health facilities. Without the required antiretroviral therapy, it is highly likely that their women’s health status deteriorated such that they faced higher chances of morbidity and ultimately mortality. 0707048E 3 The review of records at both PMTCT and ART service points showed poor data management systems as referrals from PMTCT to ART were not always documented against client names in the PMTCT registers. Communication systems between the service points were also found to be poorly structured as there were no systematic feedback mechanisms on clients referred and seen. Linkages to Wellness services were even more poorly structured as no referrals to services which fall under Wellness were documented in the PMTCT registers. Key informants interviewed suggested several possible reasons why PMTCT and ART services were not being fully utilised as was evidenced by the of 37% of women who were not retained in care as they did not return for CD4 results and the low ART utilisation rate of 23%. Possible reasons suggestions were: ignorance of the need to access ANC services, preference for traditional medicine, fear of stigmatisation within their communities and poor staff attitudes towards patients. The key informants also suggested measures they thought could improve utilisation, these include hire of more staff, improved staff wages, improved interdepartmental communication and a bottom up approach to service improvement. A suggestion was also made to include PMTCT messaging in general HIV/AIDS information education communication material so as to raise awareness of the availability of PMTCT interventions. Although there were linkages between PMTCT, ART and Wellness services, these linkages were poorly developed and drop out from services was high. Efforts to follow up on patients or to retain them in care were not well developed as the data management systems employed by the service points were not consistently used nor did they facilitate patient monitoring and follow-up. Furthermore, the structural and managerial separation of the ART service point from PMTCT as well as the lack of standard protocols for referral to Wellness introduced barriers to service utilisation for women who required these services.

Abstract Background In sub-Saharan Africa, malaria is the leading cause of morbidity and mortality. An estimated 15 million malaria cases and 40 000 malaria deaths were reported in Kenya. Malaria during pregnancy is associated with adverse health outcomes for both the mother as well as her foetus. The purpose of this study was to examine the relationship between socioeconomic correlates and the uptake of malaria prevention methods during pregnancy. Methodology: Data was drawn from the 2008-2009 Kenya Demographic and Health Survey. A total of 8098 women aged 15-49 were analysed. Stata version 12 was used for the management and analysis of data. Univariate, bivariate and multivariate analysis was carried out to meet the objectives of this study. Results: Forty-eight percent of women made use of Insecticide Treated Net (ITNs), 52 percent were administered with Intermittent Preventative Therapy (IPTp) and 36 percent made use of both measures during pregnancy. Multivariate results indicate that urban women were found to display slightly higher odds of ITN usage (1.13) and the combined usage of ITNs and IPTp (1.22) during pregnancy in comparison to rural women. Women with higher levels of education and women from middle income and rich households displayed higher odds of the uptake of these malaria prevention methods during pregnancy. Conclusion: This study has shown that socioeconomic indicators influence the usage of malaria prevention methods during pregnancy. It is therefore imperative that these factors be considered when designing and implementing policies aimed at improving the uptake of these measures during pregnancy.

MPH, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2010 / INTRODUCTION Although much focus has been placed towards rapid scale-up of antiretroviral treatment programmes and interventions for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV), very little is known about adherence to highly active antiretroviral therapy (HAART) and loss to follow-up of pregnant women in antiretroviral treatment programmes in the developing world. In this retrospective cohort analysis, we described the baseline characteristics of adult women who were pregnant at the time of HAART initiation (pregnant at start) as well as women who became pregnant during follow-up after starting HAART (pregnant after) and women who never had a pregnancy (not pregnant) during the study period. We evaluated the association of pregnancy status with adherence and loss to follow-up in these three groups of women. MATERIALS AND METHODS Themba Lethu Clinic is an urban public-sector antiretroviral rollout facility in Johannesburg, South Africa. A retrospective analysis was conducted of all adult women initiating HAART at this clinic between January 2005 and December 2007. Clinical data from these patients was analysed for differences in rates of loss to follow-up, and measured adherence rates based on CD4 cell count response and virologic suppression. Regression models were performed to determine independent predictors of adherence and loss to follow-up and compared between the three groups. Survival analysis, in the form of Kaplan-Meier plots and log-rank tests, was used to compare the time to becoming lost to follow up. RESULTS Between 1 January 2005 and 31 December 2007, 5129 women initiated HAART at Themba Lethu Clinic, Johannesburg, South Africa. Of these women, 521 (10.0%) were pregnant at the time of HAART initiation (pregnant at start) and 291 (5.6%) became pregnant during follow-up (pregnant after). Women who were pregnant at start (16.6%) of HAART had less-advanced HIV disease than the not pregnant women and pregnant women after HAART initiation 4608 (89.9%). Overall pregnant women were significantly younger than the not pregnant women and fewer pregnant women had a CD4 <100 cells/mm3 and a WHO stage III of HIV disease. There was no significant difference in the CD4 cell count response and virological suppression between the three groups of women based on pregnancy status at 6 months and 12 months (X2=2.1, p=0.347 and X2=4.4, p=0.111 respectively). However, women pregnant at start were more likely to become lost to follow-up (X2=15.8, P=<.0001) during follow up. In the multivariate Cox logistic regression model, independent predictors of loss to follow-up were pregnancy, baseline CD4 cell count and age at initiation. Being pregnant was significantly associated with being loss to follow-up. CONCLUSIONS Pregnancy is significantly associated with defaulting treatment and becoming lost to follow-up from HAART treatment programmes. Together with being pregnant, young age and a low CD4 at baseline are high risk factors for non adherence and loss to follow-up in this sub-group of the population. Early initiation of HAART with adequate pre-treatment counselling and ongoing adherence support could help improve adherence and retention in care for patients in treatment programmes in resource-limited settings. Interventions to trace patients immediately upon missed appointments would help to reduce the number of patients’ loss to follow-up. Moreover, integration of tuberculosis (TB), antenatal care (ANC) and HIV treatment services may maximize the effectiveness of interventions aimed at reducing the loss to follow-up rate. The initiation of HAART in pregnancy requires strengthened antenatal and HIV services that target women with advanced stage disease.

The study explores pertinent issues around a comprehensive provision of antiretroviral drugs to HIV positive pregnant women in South Africa from a human rights perspective. Although these drugs have been proven to significantly reduce the transmission of HIV from a pregnant mother to her newborn baby/babies at birth, the South African government for over five years refused to roll them out in the public health sector. Reasons that were provided in this regard were multifaceted and have included claims regarding their alleged toxicity, potential side effects, huge cost, inadequate infrastructure, etc until March 2004 when it announced to start a national rollout program. It is in light of this that the study sets out to explore some of the key positions within the government and amongst activist groups on the health rights of HIV positive pregnant women, and how these different positions have evolved in response to each other. In particular, the paper aims at examining how discourses of human rights were employed, and how they have impacted on the Social Work discipline. It further focuses on developing a Social Work perspective on the human rights of HIV positive pregnant women in South Africa, thereby contributing to the discipline’s professional value base and body of knowledge, which inform, inter alia, its advocacy role and social action approach. The research project was embedded in a theoretical framework often referred to as ‘standpoint research’. An archival study of local and international literature and policy documents was conducted. This was complemented with a limited qualitative study. Semi-structured interviews were conducted with a purposive sample of five interviewees representing a cross-section of positions on the topic. This data was analyzed using a three step coding procedure that allowed for categorizing, connecting, and systematically relating the gathered data to each other and to the reviewed literature. The research findings indicate that the South African government’s absence of consistency and apparent lack of political will to rollout the drugs have contributed to the deterioration of the right of HIV positive pregnant women to access health care services. The role of civil society organizations in helping to realize, promote and protect the health and related human rights of this group is emphasized. It was also found that the different strategies employed to this end speak well to Social Work’s value base, and some of its methods and approaches to practice. Social Work is therefore well placed to join and support those efforts of other segments of civil society that have been investigated in this paper. The paper concludes by making recommendations towards, inter alia, the need for the South African government to adhere to the values enshrined in the country’s Constitution; to work closely and transparently with different organs of civil society; and simultaneously implement the said ARV rollout program while building and strengthening its infrastructural capacity. The various roles Social Work could, and should, assume with regards to improving the human rights of HIV positive pregnant women in this regard are also highlighted.