Este foi um estudo de natureza qualitativa, que teve como objetivo compreender, a partir da experiência de mulheres que se tornaram mães na adolescência, o significado da maternidade no contexto de vida destas mães. Participaram 14 mulheres na faixa etária de 20 a 24 anos, residentes na periferia de Maceió, capital do estado de Alagoas. A coleta de informação foi realizada por meio de entrevistas, utilizando a história oral temática como procedimento metodológico. Foram construídas narrativas, a partir das histórias de vida das mulheres, posteriormente, analisadas à luz do referencial de gênero. Observamos que as entrevistadas tiveram sua iniciação sexual durante o período de namoro quando não haviam recebido orientações prévias sobre sexualidade ou saúde reprodutiva. Algumas mulheres conviviam com seus parceiros quando aconteceu a gravidez, porém, mesmo assim, consideraram esse fato inesperado. Houve aceitação da gravidez pela maioria delas, e também ocorreu a união, ainda que não de maneira legalizada, de muitos casais que não viviam juntos. Tentativas de abortamento, quando da não-aceitação imediata do parceiro, foram relatadas. As questões de gênero mostram-se presentes nas relações conjugais, com os parceiros figurando como provedores da família e as mulheres mantidas sob sua dependência, centradas no ambiente doméstico, assumindo responsabilidade pelo cuidado da casa, dos filhos e do companheiro. Os homens agiam mais livremente, mantendo relações extraconjugais e chegavam a agredir suas mulheres, em casa. Apesar de ressentidas com essa atitude dos companheiros, elas mantinham o relacionamento com eles. As entrevistadas deixaram explícito que lamentavam a perda da liberdade, do lazer, da oportunidade de trabalho e de estudo ao assumirem a maternidade. Por outro lado, enfatizaram seu não-arrependimento por terem levado a gravidez até o fim. Assim o cotidiano dessas mulheres parece centralizado no cuidar dos filhos, conscientes de que são elas as principais responsáveis por eles, voltando todos os seus projetos de vida para este cuidado. A vida dessas mães é marcada pelas condições de desigualdade em que vivem, social-econômica-cultural e de gênero. Dessa forma, apesar de seus desejos manifestos elas encontram poucas oportunidades objetivas de romperem com o contexto de vida em que estão inseridas. / A qualitative study, which aimed at comprehending, by the experiences of women who became mother in adolescence, the meaning of maternity in their context of life. Fourteen women from 20 to 24 years old, who lived in Maceio suburbs, capital of Alagoas State, took part in the study. The information collection was carried out through interviews, using thematic oral history as methodological procedure. We built narratives from these women’s life history and, later, we analyzed these narratives based on gender referential. We observed that interviewees had their sexual initiation during dating period when they had received no previous orientation concerning sexuality or reproductive health. Some women lived with their partners when pregnancy occurred, even though they considered it to be unexpected. The great majority of them accepted pregnancy, and there were also unions, even if they were not legalized, of many couple who did not lived together. There were reports of abortion attempts when the partner did not accept the pregnancy immediately. Gender questions are present in conjugal relations, with the partners figuring as family providers and women dependent on them, focused on domestic environment, taking the responsible by home, kids and partner’s care. Men acted freely, maintaining extra-conjugal relations and hitting their wives at home. Although resentful with their partner’s attitude, they maintained the relation. The interviews made explicit the lamentation with the lost of freedom, working and studying opportunities when assuming maternity. On the other hand, they emphasized their non-regret for taking their pregnancy till the end. This way, their daily living seems to be centered on their kids caring and they are conscious that they are the main responsible by them, turning their projects of life for this care. These mothers’ lives are marked by inequality, social, economical, cultural and gender conditions in which they live. This way, despite their manifested desire, they find few objective opportunities of breaking with life context in which they are inserted.

Globally, in low and middle-income countries 4 out of every 10 pregnancies is reported to be unintended. Having an unintended pregnancy increases the risk of maternal and infant morbidity and mortality, preterm birth, low birth weight, and decreases rates of breast-feeding. The United States (U.S.) consistently has some of the highest rates of preterm birth, infant and maternal mortality of all high-income countries and 45% of all pregnancies in the U.S. are reported to be unintended. The etiology of these outcomes and their relationship to pregnancy intention are complex and multifactorial, but we know this disproportionately effects women living in poverty both in the U.S. and globally. When couples have the knowledge, access, and power to decide when and whether to become pregnant they are more likely to seek preconception care, thus increasing the likelihood of planned pregnancies leading to improved maternal and child health outcomes. Primary prevention strategies to improve maternal/child health outcomes in the U.S. include sexual and reproductive health considerations such as increasing access to birth control. Globally, strategies include expanding access, as well as focusing on the empowerment of women and improving gender social norms. Focusing on community level norms and individual empowerment can lead to greater reproductive autonomy, which in turn leads to an increase in the uptake of birth control and family planning. This broader consideration of multiple levels of power or autonomy is often lacking in approaches taken in the U.S. More information is needed about the social context and determinants of pregnancy intention in our communities, particularly of women living in poverty. The purposes of this dissertation were to 1) to describe reproductive autonomy and family planning challenges in a population of marginalized Ecuadorian women; 2) develop a conceptual framework of reproductive autonomy from the global literature; 3) to validate a shortened form of an interpersonal violence scale used in a study of low-income pregnant women in Kentucky; and finally 4) to investigate the association between pregnancy intention and individual, interpersonal and community factors of impoverished women living in Kentucky. The qualitative study of women in Ecuador identified barriers and facilitators to family planning in a low-resource community. The major themes that emerged were that women’s autonomy was limited by men, shame was ‘keeping women quiet’, systems failed women, and as women aged they were able to build resilience in spite of these challenges. Many reported reproductive coercion, gender-based violence, and regret. Those who could leave unsupportive partners and found social support were more effective at planning their pregnancies. Evidence supports these themes are relatively common in the global literature, particularly of women living in poverty. The comprehensive review of these findings was used to develop a conceptual framework of reproductive autonomy. The Socio-Ecological Model was used to organize the data based on individual, interpersonal or community level determinants of pregnancy intention and reproductive autonomy. This new conceptual model, called the Power and Reproductive Autonomy (PARA) model, was used as a guide to analyze multiple levels of data in a secondary analysis of pregnant women living in poverty in Kentucky. Prior to this secondary analysis study, a measure used in the parent study needed to be validated. A short form of the Women’s Experience with Battering (WEB) scale was found to be psychometrically valid to measure of the impact of intimate partner violence for this population. Findings from the secondary analysis included high rates of unintended pregnancy (66%), and women with unintended pregnancy were more likely to report exposure to interpersonal violence, poor social support, and anxiety at the bivariate level. At the community (county) level those with an unintended pregnancy were more likely to live in counties with fewer social associations, and in rural communities. None of the access, gender equity, income inequality, or violence variables were correlated to pregnancy intention. In the final multilevel model, controlling for demographic variables, only being unmarried and answering the question in English were significant predictors of unintended pregnancy. The rate of social associations in a county was marginally significant with pregnancy intention, in that the presence of social associations appeared to decrease the likelihood of unintended pregnancy. Operationalizing the PARA framework to examine predictors of unintended pregnancy in Kentucky proved to not yield expected results; county level variables related to access, gender equity, and violence were not found to be significantly correlated. Women answering the question in Spanish had significantly higher rates of planned pregnancy, which is a new finding. Having opportunities for social engagement also seemed to be a protective factor in preventing unintended pregnancies. Limitations of cross-sectional data also make it a challenge to capture cumulative life stressors which could contribute to poor reproductive autonomy. Future studies may yield a greater understanding of the social context of pregnancy intention if more interpersonal data related specifically to reproductive autonomy are in the model, such as reproductive coercion, relationship power, communication, and contraceptive decision making. Additionally, further examination of structures or systems that provide economic opportunities in the community is a promising area of reproductive autonomy and pregnancy intention research.

No description available.

No description available.

<p>Teenage pregnancy is one of the major public health problems facing teenage girls in Zambia (Webb, 2000 / Warenius, 2008). Teenage girls‟ access to and utilization of adolescent&nbsp / reproductive health (ARH) services is important for the prevention of teenage pregnancies and sexually transmitted infections (STIs) amongst teenagers.High incidence of teenage pregnancies has been noted in the district despite availability of ARHservices. Teenage pregnancy is a major contributing factor to the high school drop-out rate amongst the girls and is one of the challenges faced by non-governmental organizations (NGOs) that support girl child education, such as the campaign for female&nbsp / education (CAMFED) as well as for government agencies such as the Ministry of Education. The high incidence of teenage pregnancies could be an indication of poor access to&nbsp / and utilization of ARH services and therefore an assessment of the accessibility and utilization of the ARH services was done to explore the reasons for this.This research aimed to explore the factors affecting teenage girls‟ access to and utilization of ARH services in the Mpika district, Zambia. The research was a qualitative, descriptive and exploratory study using individual interviews with ten in-school teenage girls, four key informants rendering ARH services and a focus group discussion (FGD) with ten pregnant teenage girls. By exploring these particpants‟ perceptions and experiences, appropriate interventions to improve accessibility to and utilization of ARH services could be designed that would be appropriate for the local context in order for them to be effective. Thematic analysis with categorizing and coding methods was used to analyze the data. The study used the theory of planned behaviour (TPB) which stipulates that an individual‟s attitude,subjective norms and perceived behavioural control influence behaviour as a framework to explain the findings of the results of the study. The findings of the study indicated that physical, psychological and social barriers hindered adolescents from accessing and utilizing ARH services. The findings also suggested that high levels of knowledge about RH services do not necessarily translate into accessibility and utilization of ARH services. Accessibility to and utilization of ARH services by adolescents can also be determined by an individual‟s attitude, subjective norms, and perceived behavioural control as illustrated by the TPB. Adolescents need to feel comfortable using ARH services. Therefore the three variables of TPB should be taken into consideration when designing comprehensive ARH programmes in order to accommodate the unique reproductive health needs of the adolescents. There is need to encourage participation in and involvement of adolescents in planning and&nbsp / &nbsp / implementation of ARH programmes. The participants also made recommendations which included strengthening information and education on ARH, strengthening adolescent-friendly services, improving staffing levels and promotion of school health services.</p>

Background: The Division of Global HIV/AIDS at the Centers for Disease Control and Prevention (CDC) is working on a public health evaluation (PHE) in the eastern districts of Botswana. This PHE aims to evaluate the effectiveness of Project AIM, a group-level intervention designed to reduce HIV risk behaviors in youth ages 11 to 14, when combined with the regular Botswana Skills for Life Curriculum, a standard HIV prevention education curriculum in Botswana schools. In order to evaluate Project AIM, a self-report survey and a biological testing for herpes simplex virus type 2 (HSV-2) will be conducted. Methodology: Based on studies done on the psychosocial impact of HSV-2 diagnosis on asymptomatic individuals in the USA, the literature recommends providing pre and post counseling and education to individuals testing for genital herpes to help cope and diminish the psychosocial impact of the diagnosis. In order to prepare Botswana’s clinics and schools participating in the PHE to provide the support for newly diagnosed adolescents with HSV-2, guidance materials were developed for health care practitioners and school guidance teachers. Materials were created using Information Mapping technique to analyze, organize, and present the information, and the Microsoft Office Flesch Kinkade Grade Level (FK) tool to assess the readability levels of the materials. Results: Guidance materials were prepared using the 7±2 theoretical limit of human short-term memory information mapping rule, and the FK grade levels of 6.0 to 8.0 recommended readability scores. Guidance materials included information regarding HSV-2 symptoms, treatment, and prevention. They also included information on the PHE study, youth friendly health services, counseling and education, clinic referrals and contact information. Conclusions: The development of guidance materials for schools and clinic participants of the CDC PHE in Botswana will provide health practitioners and school guidance teachers with accurate HSV-2 information to counsel and educate student participants in this research study. The guidance materials should help students cope with potential psychosocial disorders associated with pre and post diagnosis of HSV-2.

En graviditet och förlossning är i de allra flesta fall en normal livshändelse. De senaste decennierna har andelen instrumentella- och kejsarsnittsförlossningar ökat på bekostnad av den normala förlossningen. Trots fler interventioner ses ingen skillnad i den maternella och perinatala morbiditeten och mortaliteten. I barnmorskans arbetsområde ingår att handlägga den normala graviditeten och förlossningen. Syftet med studien var att beskriva hur barnmorskan kan främja en normal förlossning. Studien genomfördes som en litteraturstudie där 13 vetenskapliga artiklar, med både kvantitativ och kvalitativ ansats, analyserades. I resultatet framkom tre kategorier som beskriver hur barnmorskan främjar normal förlossning. Barnmorskan skapar genom närhet en god relation till kvinnan och ger vägledning. Genom att använda sig själv som kunskapskälla bidrar barnmorskans sinnen, erfarenheter av tidigare förlossningar och formell kunskap till att fatta korrekta beslut. Barnmorskan stödjer och bekräftar det normala individuellt efter kvinnans behov, vilket skapar en säker miljö runt kvinnan och förhindrar onödiga interventioner. Då det råder en medicinsk kultur inom förlossningsvården, behöver barnmorskans arbete kring normal förlossning stärkas. Forskning behövs på organisationsnivå, eftersom omgivande system inverkar på barnmorskans arbete med att främja den normala förlossningen. / Pregnancy and childbirth are in most cases a normal life event. Over the past decades the rate of instrumental birth and caesarean sections has increased at the expense of normal birth. Despite more interventions no difference is seen in the maternal or perinatal morbidity or mortality. The midwife’s work encompasses the normal pregnancy and labour. The aim of this study was to describe how the midwife can promote normal birth. The study was conducted as a literature study in which 13 scientific articles, with both quantitative and qualitative approach, were analyzed. Three categories emerged that explained how the midwife promotes normal birth. The midwife creates through closeness a positive relationship to the woman and gives guidance. By using herself as a source of knowledge, the midwife’s senses, experiences from previous labours and formal knowledge, contribute to make correct decisions. The midwife supports and confirms the normalcy, from the woman’s individual needs, and thereby creates a safe environment for the woman that prevents her from unnecessary interventions. As there is a medical culture within the maternity care, the midwife’s work with normal birth needs to be strengthened. Since the organization has an impact on the midwife’s promoting work, further research is needed in this area.

Whithin the recent human centered development approach, the mission of development&#039 / s declared aims are alleviating poverty, increasing choices by reducing &#039 / risks&#039 / and empowering women. In line with the human development framework, Reproductive Health program aims at improving women&#039 / s health, enlarging women&#039 / s chices and engendering reproductive rights. The scope of &#039 / empowerment&#039 / is conceptualized as strenthening their capabilities to prevent sexual reproductive health risks, thereby enlarging their reproductive choices whithout reflecting on the role of general political economic structures. this thesis argues that while general health indicators and life choices and rights of poor women are decreasing due to neoliberal shrinkage of social policy and flexible working regimes, the sole focus on reproductive health and rights by development agents is irrelevant. In line with this argument, this study draws upon post-development theory in order to argue that development is a historically specific representation of social reality which permits particular modes of knowing while disqualifying others for perpetuating gobal hegemonic regimes.

<p>Teenage pregnancy is one of the major public health problems facing teenage girls in Zambia (Webb, 2000 / Warenius, 2008). Teenage girls‟ access to and utilization of adolescent&nbsp / reproductive health (ARH) services is important for the prevention of teenage pregnancies and sexually transmitted infections (STIs) amongst teenagers.High incidence of teenage pregnancies has been noted in the district despite availability of ARHservices. Teenage pregnancy is a major contributing factor to the high school drop-out rate amongst the girls and is one of the challenges faced by non-governmental organizations (NGOs) that support girl child education, such as the campaign for female&nbsp / education (CAMFED) as well as for government agencies such as the Ministry of Education. The high incidence of teenage pregnancies could be an indication of poor access to&nbsp / and utilization of ARH services and therefore an assessment of the accessibility and utilization of the ARH services was done to explore the reasons for this.This research aimed to explore the factors affecting teenage girls‟ access to and utilization of ARH services in the Mpika district, Zambia. The research was a qualitative, descriptive and exploratory study using individual interviews with ten in-school teenage girls, four key informants rendering ARH services and a focus group discussion (FGD) with ten pregnant teenage girls. By exploring these particpants‟ perceptions and experiences, appropriate interventions to improve accessibility to and utilization of ARH services could be designed that would be appropriate for the local context in order for them to be effective. Thematic analysis with categorizing and coding methods was used to analyze the data. The study used the theory of planned behaviour (TPB) which stipulates that an individual‟s attitude,subjective norms and perceived behavioural control influence behaviour as a framework to explain the findings of the results of the study. The findings of the study indicated that physical, psychological and social barriers hindered adolescents from accessing and utilizing ARH services. The findings also suggested that high levels of knowledge about RH services do not necessarily translate into accessibility and utilization of ARH services. Accessibility to and utilization of ARH services by adolescents can also be determined by an individual‟s attitude, subjective norms, and perceived behavioural control as illustrated by the TPB. Adolescents need to feel comfortable using ARH services. Therefore the three variables of TPB should be taken into consideration when designing comprehensive ARH programmes in order to accommodate the unique reproductive health needs of the adolescents. There is need to encourage participation in and involvement of adolescents in planning and&nbsp / &nbsp / implementation of ARH programmes. The participants also made recommendations which included strengthening information and education on ARH, strengthening adolescent-friendly services, improving staffing levels and promotion of school health services.</p>

Background: Adolescents in Botswana, especially women, face many sexual and reproductive health (SRH) challenges including high maternal mortality, sexually transmitted infections (STIs) including HIV, and unintended pregnancies, despite available SRH services. The youth friendly service (YFS) concept has been initiated and various strategies developed to address adolescents concerns. However, services remain underutilized and barriers to accessing services still exist. Aim: The aim of this study was to determine patterns of utilization of sexual and reproductive health services by adolescents attending senior secondary schools in Gaborone in 2012. The specific objectives were to: identify SRH services utilized by adolescents in the district; identify factors associated with adolescent utilization of YFS in the district; and determine barriers and facilitators to utilization of available YFS by adolescents. Design: This was a health systems research, which was conducted through an observational study, with descriptive and analytic components. Methods: 506 adolescents attending at the three (3) senior secondary schools in Gaborone were sampled through a simple random sampling strategy in each school. Parental consent and assent from participants was requested before respondents completed a self-administered questionnaire which was designed for the data collection. The questionnaire was pilot tested prior to the study. SPSS version 16 was used to analyse the data. A chi-squared test and logistic regression were used investigate association, and a p-value <0.05 was considered as statistically significant. Results: The findings of this study revealed that utilization of SRH by adolescents was low and the level of awareness of youth friendly services was also low. The study revealed that utilization of SRH was higher among female adolescents compared to their male counterparts. The study identified factors which hinder adolescents YFS utilization, which include: location of the facility, no interest in YFS, staff attitudes and behaviours, and inconvenient hours of operation. Conclusion: Identifying patterns of utilization of SRH services by adolescents attending senior secondary schools in Gaborone can help strengthen programmes at all levels of service delivery and the country at large. The Botswana Ministries of Health, and Education and Skills Development can re-orientate, or develop new initiatives that will deal with barriers to access and assist adolescents to fully utilize the available services. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2014.