A lack of contraception use and contraceptive method discontinuation are common causes of unintended pregnancy in the Eastern Cape. The most common reason for method discontinuation among childbearing women is the unacceptable side effects of their contraceptive choices. Both depression and sexual dysfunction are given as side effects of contraceptive use; however, there is little evidence to support these effects. This randomised, single-blind controlled trial conducted in East London, South Africa, Investigated the effects of the initiation of a long-acting injectable contraceptive, Depot Medroxyprogesterone Acetate (DMP A), compared with the initiation of a copper Intrauterine Contraceptive Device (Cu-IUD) after childbirth on depression and sexual functioning. After counselling, 242consenting pregnant women were randomised to receive DMP A or a Cu IUD within 48 hours of childbirth, in a ratio of 1:1. Primary outcome measures were depression and sexual dysfunction evaluated by validated instruments. Questionnaires were administered at baseline, and telephonically at one month and three months after randomisation. The telephonic interviewer was blinded to the participants' group allocation. English and Xhosa versions of the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale were used to assess depression. The Arizona Sexual Functioning Scale was used to assess sexual functioning. For these primary outcomes, median scores between the intervention groups were compared, as well as the number of events (dichotomous data) in each intervention group. There relative effects of these interventions were summarised by calculating risk ratios, with 95% confidence intervals. Statistical tests used included the Shapiro-Wilk test, T-test, and Wilcoxon test. There were not consistently statistically significant differences in the risk of depression or sexual dysfunction between the intervention groups in this study. However, there was a trend towards more depression in the DMPA group which was statistically significant for mean EPDS score at the one month and for the BDI score three month assessments compared with the IUD group. There was also a trend to more sexual dysfunction with DMPA, but the only statistically significant difference was that fewer women in the DMPA group resumed sexual intercourse within the first month of treatment than in the IUD group. The author's recommendations from the study are that, firstly, family planning providers should inform women during contraceptive counselling that there is no certainty that DMPA causes depression and/or sexual dysfunction; however, it may do so in the postpartum period. Secondly, contraceptive users can continue to use DMPA with confidence as a convenient and effective method of preventing unintended pregnancy. Thirdly, the trend towards postpartum depression and sexual dysfunction in the DMPA group of this study justifies further research with a larger sample size, to include women from various social settings, and for a longer period of follow-up. Lastly, the Cu-IUD is a good alternative to DMPA in women who experience intolerable effects with the latter.

Dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, In fulfilment of the requirements for the degree of Master of Science in Nursing Education Johannesburg, 2015 / This is an exploratory, descriptive study intending to determine factors that influence the uptake of Reproductive Health Services (RHS) by female students at the university in Johannesburg with a view to improving access and delivery of service in a more efficient manner. Despite the availability of free, accessible and confidential RHS on campus, anecdotal data shows an increased number of students who present with unintended pregnancies and soliciting termination of pregnancy. Through the survey and semi-structured interviews the researcher attempts to determine factors influencing the uptake of campus RHS by female students. The present text seeks to answer the following research questions: What is the socio-demographic profile of actual and potential users of RHS on campus and what factors influence the uptake of RHS on campus? Keywords: Reproductive health, access, utilisation, unwanted pregnancy

Accompaniment models have been used globally to help address barriers to abortion access. Access to abortion is an important issue facing individuals in Canada today. In Canada, abortion doulas provide accompaniment services, even though they are not formally integrated into the abortion care system. This thesis explores the concept of accompaniment in the context of abortion care and provides insight into the experiences and perspectives of abortion doulas active in Canada. This is accomplished through a scoping review and in-depth interviews with abortion doulas across Canada. Results suggest that accompaniment models are beneficial to abortion care and can improve accessibility. Further, abortion doula support helps abortion seekers overcome barriers to care and empower those providing the support. Abortion doulas have many suggestions for improvements to the abortion care system in Canada and have valuable insights into the barriers which exist today. Abortion care can be improved by integrating abortion doula support into the abortion care system, but further research is needed to develop and evaluate interventions. This research is a starting point and aims to contribute to the literature in an under-researched area. -- Des modèles d'accompagnement ont été utilisés dans le monde entier pour aider à lever les obstacles à l'accès à l'avortement. L'accès à l'avortement est une question importante auquel les individus au Canada sont confrontés. Au Canada, les doulas spécialisées dans l'avortement fournissent des services d'accompagnement, même si elles ne sont pas officiellement intégrées au système de soins lié à l'avortement. Cette thèse explore le concept d'accompagnement dans le contexte des soins liés à l'avortement et donnera un aperçu des expériences ainsi que les points de vue des doulas spécialisées dans ce domaine au Canada. Afin de démontrer ceci, la thèse s'appuie sur un examen de la portée de l'étude et sur des entretiens approfondis avec des doulas spécialisées dans l'avortement au Canada. Les résultats suggèrent que les modèles d'accompagnement sont bénéfiques aux soins liés à l'avortement et peuvent en améliorer l'accessibilité. De plus, le soutien des doulas aide les personnes qui cherchent à se faire avorter à surmonter les obstacles aux soins et renforce l'autonomie de celles qui offrent ce soutien. Les doulas d'avortement ont de nombreuses suggestions pour améliorer le système de soins en matière d'avortements au Canada et ont des idées précieuses au sujet des obstacles qui existent aujourd'hui. Les soins liés à l'avortement peuvent être améliorés en intégrant le soutien des doulas dans le système de soins liés à l'avortement, mais d'autres recherches sont nécessaires afin de développer et évaluer les interventions. Cette recherche est un point de départ et vise à apporter une contribution à la littérature sur un domaine peu étudié.

It is estimated that 38 million people currently live with HIV-1. Of the 38 million currently infected, 19.2 million women are infected compared to 17 million men, indicating a clear disproportion. As such, understanding mechanisms that result in increased susceptibly in women is critical to develop more efficacious prevention strategies. The epithelial cells that line the lower female reproductive tract are the first line of defense against invading pathogens. The current consensus in the field is that HIV-1 can cross the mucosal epithelium in two ways: paracellular passage and transcytosis. There are several endocytic pathway associated proteins within vaginal epithelial cells that may have a role in viral transcytosis, however, little is known about their role. One of these is Lysosomal Associated Membrane Protein 3 (LAMP3), which has been shown to be upregulated following viral exposure and involved in viral trafficking. The mechanisms regarding the early events of transmission of HIV-1 across vaginal epithelial cells remains unclear and warrant further investigation. This study was designed to examine the mechanism of how HIV1 crosses vaginal epithelial cells and potential interactions of LAMP3 and HIV-1. / Thesis / Master of Science (MSc)

Thesis (Ph. D.)--University of Hawaii at Manoa, 2003. / Includes bibliographical references (leaves 449-459).

Thesis (Ph.D.)--McMaster University, 2004. / Advisor: Charlene Miall. Includes bibliographical references (leaves 274-282)

This research is one contribution to understanding the nature of policy and of power. the interaction of the state and its machinery with individuals at all levels, the tensions between public and private choices and responsibilities, between public health and clinical health care. Adapting a policy analysis approach, this thesis provides a case study of the development and implementation of reproductive health policies in Ghana. The aim is to enhance understanding of why there are differences between policy and practice and what the potentials are for integrating STD/HIV management into MCH/FP services in Ghana to improve reproductive health. This thesis argues that all elements of policy and policy analysis are located within a 'contextual framework' and are influenced by a range of contextual factors (defined and illustrated through the thesis) which are seldom taken into account in policy process and analysis. It is argued that understanding the different levels of context is fundamental to understanding the processes of policy development and implementation, the actions of actors at all levels and the policy outcomes. Using a multi-level focus and a combination of approaches, this thesis identifies the contextual factors and their manifestations at each level of the policy process and illustrates how they impact on policy. The analysis synthesises macro and micro dimensions gaining a more comprehensive understanding of the influences on and gaps between policy development and implementation. At the implementation level, 27 clinics were visited and 94 clinic staff interviewed in one rural region of Ghana, to ascertain what STD/HIV management services are actually being provided and what factors influence service provision (policy implementation). Interviews with community leaders and focus groups with villagers were conducted in the same region to explore community perspectives of disease and health care services and understand the factors influencing service utilisation (policy outcome). The role of the regional health administration as an intermediary was considered and understanding sought of the concepts of power which influence administrative and management structures. The national level interviews with government and Ministry of Health officials and with donor, NGO and national group representatives, provide further insight into the concepts of power and status and who influences policy making. Finally, all elements are brought together and discussed, a reworked framework is presented and suggestions for future policy and research directions are made.

Early sexual debut whether voluntary or coerced increases exposure to high risk sex which leads to unplanned pregnancy, sexually transmitted infections including HIV and reproductive heal th problems during adolescence. This study aim s to examine the risk factors for age of sexual debut, either voluntary or coerced among Black African female adolescents from the Birth to Twenty cohort study in Soweto, South Africa . Part A is the study protocol which outlines the rationale for conducting this study , study aim, research methodology, analysis plan and ethical considerations. Part B forms the literature review which gives a summary of the existing literature and provides context for the dissertation. The objectives of the literature review were to identify published literature on determinants of either voluntary or coerced sexual debut in adolescents and identify gaps for further research. Part C is the manuscript presenting the results and discussion on the implications of key findings. The results showed that there are many Black African female adolescents who are engaging in early sexual debut and there is prevalenc e of coerced sexual debut among adolescents of similar age. Socio-economic status and maternal education were found to be significantly associated with coerced sexual debut. There is a need for interventions to delay sexual debut among young female adolescents from low socio-economic backgrounds and lower maternal education.

Magister Curationis - MCur / Background: The changes in sexual and reproductive behaviour of young people as they become students, has been widely documented. International and local studies promote the development of student-centred, comprehensive and accessible reproductive health services. In order to establish effective reproductive health care within education institutions, it is strongly recommended that one should understand the local context well. Aim: This study aimed to describe the reproductive health knowledge, attitudes and practices of student nurses at a select private nursing college in South Africa.

Detta examensarbete handlar om hur par upplever att vara infertila och deras längtan efter att bli föräldrar. Infertilitet väcker starka känslor hos paret och är någonting som de själva inte kan styra över. Arbetet baseras på tio vetenskapliga artiklar som funnits via sökningar i databaser som låg till grund för analysen. Av dessa artiklar delades deras resultat in i tre teman med tre underteman vardera. Dessa teman svarar på arbetets syfte i resultatdelen, det vill säga parets upplevelse av infertilitet. Resultatet visade att par upplevde infertiliteten som en omtumlande tid i livet då de kände sig maktlösa i situationen. Par försökte hitta en annan mening i vardagen och det var vanligt att istället satsa på karriär, utbildning, resor eller hobbys. Infertiliteten påverkade individen och paret i och med de känslor som uppkom. Detta medförde tankar på om relationen exempelvis skulle vara hållbar utan barn. Resultatet visade även att par upplevde ett tryck ifrån vänner och familj. De hade svårt att glädjas när vänner och syskon fick barn och kände skuld över att inte kunna erbjuda deras föräldrar barnbarn. Stöd i olika former efterfrågades där andra par i samma situation tycktes vara de enda som förstod vad de genomgick. Hälso- och sjukvården sågs som en viktig källa till information. Det är tydligt att infertilitet påverkar paret med många känslor och påfrestningar men i slutändan har det dock visats stärka paret på ett eller annat sätt. I våra slutsatser framkommer det att sjuksköterskan har en viktig roll i mötet med paret. Genom att sjuksköterskan tillämpar personcentrerad vård ges  örutsättningen att förhindra vårdlidande. / Background: Infertility is more common than many people think and can be due to various factors. The occurrence is equally common in both sexes and various treatment methods are available to take. Infertility rarely go unnoticed and couples affected more or less. Aim: The aim of the study was to highlight the heterosexual couple's experience of infertility. Method: A literature based study was done through a qualitative approach. The database Cinahl was used in the systematic searches. In total, the study is based on ten qualitative articles and the analysis resulted in three themes with three subthemes each. Results: The couples felt that their relationship was put to the test. They isolated themselves from family and friends because they constantly were reminded of their situation. Seeking support from others with infertility problems on Internet was common. Conclusion: The desire to become a parent was for all couples central but with the diagnosis life couldn’t take the way that was intended. The relationship was affected more or less, and support from various sources and of different types were needed. The importance of the nurse responds couple on a person-centered way highlighted. Person- centered care took advantage of the patient's resources and reduced suffering.