Health care providers’ (N = 421) implicit perceptions of pregnant women based on age, race or ethnicity, marital status, and socioeconomic status are assessed through a true-experiment design. Ordinal and binary regression analyses revealed that respondents felt more pity for an unmarried than married pregnant woman and more anger toward an unemployed pregnant woman without health insurance compared to a pregnant woman who was employed with health insurance. Male, Asian, and Hispanic respondents were less likely to help the pregnant woman, Black and protestant respondents were more likely to express some degree of anger toward the pregnant woman, and male and protestant respondents assigned more responsibility to the woman for her pregnancy. Additionally, respondents’ open-ended suggestions varied based on the pregnant woman’s characteristics. Implications and future directions are discussed.

Background: Approximately 70% of US adults currently receiving opioid agonist treatment (OAT) for opioid use disorder are of reproductive age. Among women receiving OAT at risk of having an unintended pregnancy, typically less than half report any current contraceptive use compared to 90% in the general population. In addition, the rate of unintended pregnancy among women receiving OAT is disproportionately higher than the general population (~80% vs. 45%, respectively). Lack of knowledge about family planning may be contributing to decreased rates of contraceptive use and increased rates of unintended pregnancy among women receiving OAT. Method: Participants were a convenience sample of women and men receiving OAT or a comparison group receiving primary care (PC) services. Family planning knowledge was assessed with the recently validated Contraceptive Knowledge Assessment (CKA), a self-administered 25-question multiple-choice survey. A two-way ANOVA, with fixed factors (i.e. patient sample and sex), compared the total number of correct responses for all questions and five more specific content areas (p<.05). Results: Overall, 332 participants completed this survey. The mean percent of total correct responses was significantly lower in the OAT sample (n=167) compared to the PC sample (n=165), 47% vs. 53% correct, respectively (p<.001) or approximately 1.5 questions less. The mean percent of correct responses in four of the five content areas was also lower among the OAT sample compared to the PC sample (ps<.01). The mean percent of total correct responses was significantly higher among women (n=169) than men (n=163), 56% vs. 44% correct, respectively (p<.0001) or approximately 3 questions more. The percent of correct responses in four of the five content areas was also higher among women than men (ps<.01). Conclusion: Given the substantial discrepancy in rates of contraceptive use and unintended pregnancy between individuals receiving OAT and the general population, it is somewhat unexpected that individuals receiving OAT did not have lower levels of family planning knowledge, although patients in both samples only answered approximately 50% of the questions correctly. Results from the present study suggest deficits in family planning knowledge, while statistically significant, may be less clinically so. Overall, lack of family planning knowledge is likely only playing a small role in population differences in contraceptive use and unintended pregnancy and interventions aimed at decreasing these differences will need to address other barriers to accessing family planning services and utilizing contraception in this population.

Pregnancy intention is extensively examined in the literature and the concept of "unintended" pregnancy is considered a significant health problem. Large efforts have been made to reduce negative health consequences presumably associated with pregnancies that are unexpected, unwanted, or mistimed but have had limited impact. A study was conducted to examine contextual issues surrounding women's experiences with pregnancy intention its intersection with knowledge, perceptions, and use of emergency contraception in a population of female university students. The project was a mixed method study including a survey examining demographic characteristics, sexual history, and knowledge and use characteristics in addition to interviews exploring prospective perceptions of pregnancy intention. An integrative review informed the background of the study demonstrating the need for expansion of current concepts of pregnancy intention that inform measurement and subsequent interventions. Quantitative survey results provide new information including higher rates of use in comparison to previous studies but persistence of misinformation. Qualitative interview findings illustrate a process by which individual agency in terms of sexual and pregnancy decision making is influenced by a precursor of the embodiment of convictions and empowerment. Combined conclusions confirm the need of exploring the role of the social context on pregnancy intention, suggest ways in which nurses can empower women to be their own agents of health, and start discussions of how intervention approaches to pregnancy intention can be improved.

The Title X Family Planning Program (Public Law 91-572), enacted by President Richard Nixon in 1970, provides federal funds for voluntary, confidential family planning services to all women, regardless of their age or economic status. This federal legislation aspired to prevent unintended pregnancies and poor birth outcomes to those in most need. However, over the past three decades, Title X has faced political, financial and social challenges. Despite its enormous success in improving the health and well-being of women and children by decreasing unintended pregnancies, the need for abortions and providing key comprehensive preventive services, without a newfound political will similar to that during which it was conceived, the future of Title X may be in jeopardy. This study grounded theoretically and methodologically in a feminist policy analysis approach, critically examined the maturation of Title X by employing a mixed methodology design that consisted of a thematic analysis on Title X's legislative history and the conduction and analysis of oral histories. In Phase I, themes were extracted from the federal bills included in Title X's legislative history, which assisted in the identification of the issues that this policy has endured. In Phase II, a semi-structured interview guide was developed based upon the themes and findings from the thematic analysis as well as from pre-determined constructs from McPhail's Feminist Policy Analysis Framework, to explore key informants' perceptions, recollections and experiences regarding the Title X program. By examining Title X through a feminist lens, various issues were exposed and critically examined, including issues that are typically ignored by traditional policy analyses. Moreover, understanding the historical underpinnings and evolutions of a policy and recognizing past failures and achievements are necessary in order to make informed future decisions. Implications for research, practice and policy are discussed.

Background: College settings are likely environments for Black women to contract STIs (including HIV) or experience unintentional/unwanted pregnancies. Effective prevention strategies for this population include dialogue and activities that focus on gender, maturity, cultural barriers, personal strength, and information needs. However, technological advancements (including virtual reality) and innovation are limited in prevention efforts. Methods: Four 90-minute focus group sessions were conducted in a convenience sample of Black college females (ages 18 years or older) and a research-intensive public institution in the southeast. A series of surveys were distributed during each audio-recorded focus group session. A mixed-method approach to data analysis was based on applications of the Health Belief Model constructs to three principal research questions: (1) Q1: How do Black college females perceive the importance of sexual risk topics? (2) What are the experiences and attitudes of Black college females regarding the use of VR for education and training versus video game entertainment (i.e. “gaming)? and (3) Among Black college females, what sexual risk topics are considered most relevant to a VR education and training platform? Results: Each of four study cohorts enrolled between 2-6 participants each (n=15). Participant ages ranged from 18-48 (x̅=28.6, σ=9.2) years within age groups of 18-24 years (60%, n=9), 25-34 years (26.7%, n=4), and 35 years or above (13.3%, n=2). The majority of participants (86.7%, n=13) were enrolled as full-time students, and resided in various off-campus locations (73.3%; n=11). Assessments of sexual risk topic importance were reported based on aggregated Survey 1 Lickert scale values. The majority of participants equally viewed the topics of HIV and STI status as important, mostly important, or very important. Other notable concerns include sex with drug/alcohol use, risk of intimate partner violence, and sexual communication (e.g. partners and peers. Despite the lack of formal virtual reality knowledge, the majority of participants reported experience with VF technology via “gaming” (e.g. SIMS). They also concluded that a virtual reality platform for sexual health education and training should involve comprehensive approaches to HIV/STI and unintentional pregnancy via use of barrier methods, including birth control, as well as facilitation of sexual communication. Discussion: This research represents a unique approach to the identification of sexual health risk importance for HIV/STI transmission, as well as unintentional pregnancy, in Black college females. Although a successful demonstration of feasibility, this research is formative in nature – results should be interpreted as preliminary. However, methods and concepts presented in this thesis hold the potential for scientific contribution in prevention research, clinical practice, and other fields of study.

Magister Artium - MA / Globally, teenage pregnancy remains a disturbing phenomenon which impacts on the lives of teenagers, their families and society as a whole. Numerous attempts at addressing the problem have seen a decline in fertility rates but agreement still exists that the incidence of young girls bearing children is unacceptably high. Studies conducted over the years have emphasised both the causes and consequences of teenage births. Many studies too have explored the benefits of preventative strategies. Yet, despite all this, teenage pregnancy remains a cause for concern with many teenage girls remaining sexually active after a first pregnancy, and exposing themselves to subsequent pregnancies and births. This study was focused on teenage girls who had experienced unintended repeat pregnancies. Through the research a deeper understanding of the meanings that female teenagers ascribe to repeat pregnancies, were sought. A sample group of teenage mothers were allowed to take a step back from their experience of the repeat pregnancy; to think deeply about the experience, and to reflect on what they had learnt and how it has impacted on their current lives. The researcher employed a qualitative approach with a descriptive, explorative design in order to obtain a rich description of the experiences of teenage mothers who have been through a repeat pregnancy. The goal of the study was to explore and describe the reflections of these teenage mothers who had experienced unintended, repeat pregnancies. Data was obtained through semi-structured individual interviews where an interview guide was used. The data was analysed according to the steps outlined by Creswell (2009). Findings were noted and recommendations made. These recommendations are designed for role-players involved with teenagers and youth in general. Emphasis was placed on recommendations to professionals, like educators, healthcare workers and social workers who are at the coalface of dealing with teenagers who engage in sexual activity. Finally, recommendations for further research were made.

Magister Public Health - MPH / Dual protection is protection against unwanted pregnancy, HIV and other sexually transmitted infections and a means of achieving safer sex and birth control (WHO, 2012). It is one of the essential tools promoted by the WHO for preventing unintended pregnancies and sexual transmitted infections among HIV-positive women to reduce dual risk of unintended pregnancies, re-infections and transmission of HIV in the cases of sero-discordant couples. However, the use of dual method use among HIV-positive women in Zimbabwe is poorly described. Hence to fill in the existing research gap, this study aims to explore the factors influencing dual protection use by HIV- positive women participating in a prevention of mother-to-child transmission (PMTCT) program in an urban setting in Zimbabwe. Methodology: A qualitative exploratory study design with a combination of qualitative research methods including interviews and focus group discussions was conducted. A total of five focus group discussions (FGDs) each consisting of 8-12 participants was conducted with a total of 51 women. Five in-depth interviews were conducted with key informants. All interviews and FGDs were audio recorded using a digital voice recorder. The interviews were conducted in Shona and translated into English. Data analysis was done manually using thematic coding. Codes emerged from the data using an inductive approach. Ethical principles of research and rigour were observed throughout the study. Results: Dual protection use was low among the HIV-positive women. Absolutely non-use of contraceptive was reported by some women. The main methods of contraceptives were the pill, depo provera and condoms. Inconsistent condom use was mentioned among the few women who reported using condoms. Many barriers to contraceptives use among HIV-positive women in Zimbabwe were identified. However there were a few facilitating factors too. Health system factors associated with health care workers (HCWs) related factors and service delivery processes were reported as major barriers to contraceptive use. Women expressed negative attitude towards condom use associating them with unfaithfulness. Facilitators of contraceptive use identified were couples' HIV testing and counselling, women's increase in CD4 count result, fear of vertical transmission and HIV sero-discordance between couples. Conclusion and Recommendations: In conclusion, dual protection use among HIV-positive women in this community was low. Health system factors were the main barriers to contraceptives use whilst health related factors were the main facilitators. HIV-positive women still face challenges in accessing and utilisation of contraceptives. Hence the barriers to contraceptive use needs to be addressed at the same time promoting the facilitators.

BACKGROUND: Most women within reproductive ages living in Low- and Middle-Income Countries, have limited or no access to education on sexual and reproductive health and contraception, yet about 1.9 billon women in LMICs own a mobile phone. The exposure to digital health services has the potential to contribute to improving awareness, influencing positive perceptions, beliefs and promoting SRH and contraception.AIM: To explore user views and perceptions on the Grace Health’s (a digital health service) ability to improve awareness on sexual reproductive health and contraception among Ghanaian, Nigerian and Kenyan women aged 18-35.METHODOLOGY: A qualitative design using phenomenography to interview women remotely on women’s perception of digital health services through their own experience with using the Grace health chat bot and app. Also, their views were sought on how other women are gaining awareness and impacts on sexual reproductive health and contraception from the digital health services.RESULTS: Seven categories on digital health services emerged, with key findings presented as Safe days, ovulation as contraception, impacts on SRH, Avoiding or seeking pregnancy and influence on perception.CONCLUSION: This qualitative study gives insight for research community, public health professionals, app designers, health care providers, stakeholders and civil society organisations in making decisions regarding the use of digital health service as strategic, innovative instruments for interventions in major key indicators of Sexual Reproductive Health and Rights.

Background: In the United States, currently about half (49%) of the 6.7 million pregnancies are reported as mistimed or unplanned, and this rate of unintended pregnancy is significantly higher than the rate in most other developed countries. Abortion services are critical to the prevention and management of unintended pregnancies. Abortion in the United States has been legal since the 1973; however this right has little meaning without access to safe abortion care and access is declining. Medication abortion, the use of medications to induce abortion and terminate an early pregnancy, has been legal in the United States since 2000, is ideal for the outpatient setting, and allows for increased provision of and access to abortion services. The literature assessing the provision of medication abortion has largely been conducted in populations of physicians, and combined groups of advanced practice clinicians including physician assistants (PAs), certified nurse midwives (CNMs), and nurse practitioners (NPs). No studies exist assessing provision of and barriers to medication abortion by NPs and CNMs (Advance Practice Registered Nurses or APRNs) in the state of Vermont. Purpose: This study sought to fill this gap in the literature. Data was collected in order to determine whether APRNs are providing care to women at risk for unintended pregnancy and are providing medication abortion, the characteristics of these providers, and perceived barriers or supports to practice. Methods: The design was a cross-sectional survey, using purposive sampling methods. Between July 2014 and September 2014, 21 eligible participants completed an anonymous, self-administered online survey, recruited via notifications sent out through professional listserv. The survey assessed their personal characteristics, beliefs and clinical practice related to reproductive health care and unintended pregnancy prevention and management. All participants had current APRN certification with prescriptive authority in the state of Vermont. Results: Ninety percent of respondents reported care for women of reproductive age as at least one-third of their clinical work and 85% of respondents reported seeing women with unintended pregnancies as part of their practice. Eighty-five percent agreed or strongly agreed that medication abortions fall within the scope of practice of an APRN and of a primary care provider, and 85% would like to be trained to provide medication abortions to manage unintended pregnancy. Lack of training opportunities, clinical facility constraints, and legal uncertainties were the most frequently reported barriers to provision of medication abortion. Conclusions: Many APRNs in Vermont may be interested in receiving medication abortion training. APRNs are experienced and highly trained health care professionals that have the competence and skills to provide comprehensive reproductive health care, including medication abortion. The perceived barriers of training, clinical facility constraints, and legal uncertainties are amenable to change, and can be decreased through inclusion of these topics into APRN education. The political and social climate of Vermont, combined with the findings of this preliminary study, suggest that the state of Vermont is ready, willing, and able to serve as a model for the primary provision of and improved population access to, comprehensive reproductive health care including abortion services.

Rapid repeat pregnancy (RRP) is associated with adverse maternal and infant outcomes and a range of undesirable social and economic challenges for the mother, her baby, and society. Although the consequences of RRP are well known, Zimbabwe—a country with some of the poorest maternal health indicators—has not investigated or made efforts to directly address this problem. This is confirmed by the lack of targeted programs to curb RRP, the unavailability of documented evidence regarding RRP significant risk factors, and the lack of understanding of the extent of RRP in the country. Using social cognitive theory as the theoretical framework, an unmatched case-control study was conducted using data from the Zimbabwe Demographic and Health Survey of 2015 to determine the prevalence of RRP and to assess associations between sociodemographic, sexual-relational, women's health, fertility preference, previous birth outcomes, and social factors and having an RRP in Zimbabwe. Logistic regression analysis showed statistically significant associations between all factors except for women's health characteristics. The prevalence of RRP among women of reproductive age (15–49 years) in Zimbabwe was 50.2%. The high prevalence of RRP and the multiple statistically significant associations reported in this study affirm the need for Zimbabwe to make prevention of RRP a public health priority. Zimbabwe must develop targeted interventions that work in context and integrate these into an ongoing comprehensive family planning program. In-depth research is needed to establish and understand the underlying motivations for having an RRP among Zimbabwean women. Such information may help develop targeted interventions to create social change.