Contraceptive practices entail a wide spectrum of concepts, namely, contraceptive methods, the use of contraceptives, the discontinuation of such use, and the non-use of contraceptives or failure to use them. The use of contraceptives and contraceptive services is influenced by a number of factors that either motivate or demotivate women to use contraceptives effectively. The aim of this literature review is to identify and describe factors impacting on the contraceptive practices of women. The discussion includes factors impacting positively or negatively on contraceptive practices in terms of age-related issues, education and status, religion, socio-cultural beliefs, values and norms, knowledge about contraceptives, contraceptive providers and the accessibility of contraceptive services.

Submitted in fulfillment of the requirements for the degree Masters in Psychology in the Department of Psychology, Faculty of Arts at the University of Zululand, South Africa, 2012. / Unwanted pregnancy among young unmarried South African women still remains a challenge. It has been identified that young unmarried women who are living in rural areas are more vulnerable to unwanted pregnancy. Bronfenbrenner.s theory of systems has been used in the study. The participants were sourced from eMbobeni location, a rural area in Bizana in the Eastern Cape Province. The data was collected through focus group interviews and analysed through content analysis. Group interviews were tape recorded and transcribed. Group support was provided for the participants in the focus group. Through the study it has emerged that lack of knowledge about sexuality and the protection of oneself still remains a challenge. Factors contributing towards unwanted pregnancy among young unmarried women were identified as being lack of parental support; lack of knowledge and the stigma towards contraception; pressures from the partner; ignorance, carelessness and restrictions; and shift of responsibility. / National Research Foundation (NRF)

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

M.A. / This dissertation evaluates the concept of a third alternative surrounding abortion which focuses on making abortion rare by addressing contemporary arguments. This third alternative recognises abortion as morally problematic but contends that it should be both legal and rare. Its aim is to address the overly narrow focus of the usual debate on either just the foetus or just the maternal body. In doing this it evaluates some of the current contemporary arguments surrounding abortion to show how these arguments are simply not enough. This includes questioning the social and political dimensions of the dilemma of abortion, and in particular, questions about the conditions that should be in place that will help make abortion rare. This should show how the current debate has created a clear division which has done very little to help women who are considering an abortion. Therefore the argument of making abortion rare should be supported by both Pro-Life and Pro-Choice arguments because if abortion became rare, it would mean that not only would there be fewer abortions, which is exactly what Pro-Life is arguing for, but it would also mean that women would be given more options, which is what Pro-Choice is arguing for.

This dissertation examines associations between unintended pregnancy and future maternal mental health and parenting behaviors. Put simply, I examine whether a mother who self-reports her pregnancy as being unintended at her child’s birth will have longstanding differences in mental health and parenting behaviors as her child ages. Drawing on two separate sources of data, I examine these associations taking into account three different ways of measuring unintended pregnancy. Drawing on the Fragile Families and Child Wellbeing Study (FFCWS), unintended pregnancy is measured as such when mothers report, “yes,” to a question asking them whether they considered an abortion prior to their child’s birth. In many respects, consideration of an abortion is the most definitive measure of unintended pregnancy, since it could result in termination of the pregnancy altogether; yet, it is the least utilized in the research literature. More commonly, researchers adopt measures of unintendedness by asking mothers whether or not their pregnancies were “mistimed” or “unwanted.” Drawing on the Building Strong Families (BSF) Project, unintended pregnancy is measured by two questions regarding whether the mother wanted a child with the biological father and whether the pregnancy came sooner, at about the right time, or later than she wanted (mistimed pregnancy). Appreciating the potential influence that the biological father may have on the experience of an unintended pregnancy and later parenting and mental health, all analytic models are conducted separately by family structure at the child’s birth (single mothers and mothers cohabiting with the child’s biological father). Results across the FFCW and BSF Project show that both considering an abortion and having an unwanted pregnancy were associated with considerable longstanding risk for maternal mental health and parenting behaviors, especially for mothers who report cohabiting with their child’s biological father at baseline. Within both sources of data, unintended pregnancy was associated with increased parenting stress, less engagement in parenting activities, and increased likelihood of spanking for cohabiting mothers. Notably, these identified associations remained relatively unchanged when utilizing propensity score pair matching techniques. Results from moderation analyses with the FFCWS reveal that maternal education moderates the association between considering an abortion and maternal mental health and parenting behaviors. Results from moderation analyses with the BSF Project reveal that assignment to a BSF Program altered associations between unwanted pregnancy and engagement in parenting and spanking behaviors. There was no negative link between cohabiting mother’s unwanted pregnancy and engagement in parenting for those mothers assigned to the BSF program, whereas there was a negative link in the control group. Similarly, if single mothers were assigned to the BSF treatment and reported that their pregnancy was unwanted, they were less likely to spank their three-year-old children. These findings suggest the possibility that an organized program could alter longitudinal associations between unintended pregnancy and parenting behaviors, even if the program is not targeting experiences of unintended pregnancy specifically.

Women and men’s experiences and needs in relation to induced abortion, and their views on the prevention of unintended pregnancies were explored through questionnaire studies at 10 and13 Swedish women’s clinics (Papers I–IV). Among 798 women in age range 14 – 49, 35% had experience of at least one previous abortion, and in the age range 20 – 49, 41%. The risk factors for repeat abortion were having children (Odds Ratio [OR] = 2.57), lack of emotional support (OR 2.09), unemployment or sick leave (OR 1.65), tobacco use (OR 1.56), and low educational level (OR 1.5). Among 590 men in age range 16 – 63, 32% had been involved in at least one previous abortion. The risk factors were, being a victim of violence or abuse (OR 2.62), unemployment or sick leave (OR 2.58), and having children (OR 2.0). Tobacco use was common, among both women (33%) and men (50%), and among those with repeat abortion 41% and 57%, respectively. Some considered societal efforts important for prevention, (Paper I–II). Overall care-satisfaction (Paper III) was high (74% of women and 52% of men). For women, factors associated with high care-satisfaction were being well treated by the staff (OR 11.78), sufficient pain relief (OR 3.87), adequate information about the gynaecological examination (OR 2.25), suitable contraceptive counselling (OR 2.23), and accessibility to the clinic by phone (OR 1.91). For men, the factors were being well treated by the staff (OR 5.32) and adequate information about the abortion procedure (2.64). Existential experiences and needs related to abortion were investigated among 499 women. Three components were identified (Paper IV): existential thoughts (61% of women), existential practices (48%), and humanisation of the foetus (67%). A higher presence of existential components correlated with difficulty in deciding to abort and poor psychological wellbeing after the abortion. Interviews with 24 women and 13 men on their experiences and needs related to home abortion and views on the prevention of unwanted pregnancies revealed two overarching themes (Paper V). Home abortion increased autonomy: both women and men demonstrated self-care ability. However, autonomy was related to dependence: the desire to be treated with empathy and respect on equal terms and receive adequate information adapted to individual needs. They were motivated to avoid a subsequent abortion, but planned contraceptive follow-ups were rare. Both individual and societal challenges were implied: women and men experiencing repeat abortion appeared more disadvantaged and abortion involved complex aspects beyond medical procedures and routines. Thus, abortion care should be continuously evaluated to ensure care satisfaction, safety, and contraceptive adherence. Preventive efforts would include work opportunities, sex and relationship education, and cheap and effective contraceptives. Minimising differences between socioeconomic groups is important, and both individuals and society should share the responsibility for these efforts. / De senaste åren har kvinnor fått ökade möjligheter att välja mellan olika abortprocedurer, vilket medfört att andelen medicinska aborten har ökat och utgör 89% av alla inducerade aborter före utgången av graviditetsvecka 9. Den medicinska aborten kan avslutas i hemmet om kvinnan så önskar och inga hinder finns. Generellt finns begränsad kunskap om kvinnor och framför allt män som är involverade i en abort. Socialstyrelsens register ger endast information om; vilken vecka aborten avslutas i, abortmetod (medicinsk/ kirurgisk), kvinnans ålder, kommuntillhörighet, antal barn och tidigare aborter. Det innebär att det finns begränsad möjlighet att undersöka eventuella skillnader mellan olika grupper. En relativt hög andel (40%) av de abortsökande kvinnorna har erfarenhet av att ha gjort minst en tidigare abort, men kunskap om den gruppen är begränsad. Det övergripande syftet med den här avhandlingen var att undersöka kvinnors och mäns upplevelser och behov i samband med en abort och deras syn på förebyggande insatser. Kvantitativa och kvalitativa metoder har använts i de olika delarbetena (I– V) samt teoretiska modeller som utgår från folkhälso- och omvårdnadsperspektiv. Samtliga studier är godkända av den regionala etikprövningsnämnden i Uppsala. Delarbete I–IV bygger på resultat från en multicenter studie som genomfördes 2009, där 10 och 13 svenska kvinnokliniker deltagit. Syftet med delstudie I och II var att undersöka riskfaktorer för upprepad abort bland kvinnor och män. Två enkäter (kvinna/man) delades ut på kliniken i samband med att kvinnorna sökte för abort. Enkäten besvarades av 798 kvinnor efter genomgången abort. Männen som var involverade i graviditeten blev tillfrågade att delta i studien av kvinnorna och 590 män besvarade enkäten. Separata frankerade kuvert bifogades, vilket möjliggjorde att kvinnorna och männen kunde besvara enkäten oberoende av varandra. Resultatet i delarbete I och II visade att 35% av 798 kvinnor i åldern 14 – 49 hade erfarenhet av minst en tidigare abort och den andelen var högre i åldern 20 – 49; 41%. Upprepad abort var associerat med; att ha barn (Odds Ratio [OR] = 2.57), brist på emotionellt stöd (OR 2.09), att vara arbetslös eller sjukskriven (OR 1.65), rökning/snusning (OR 1.56), och låg utbildningsnivå (OR 1.5). För de 590 männen i åldern 16 – 63 hade 32% erfarenhet av minst en tidigare abort. Upprepad abort var associerat med; att ha varit utsatt för våld eller tvång (OR 2.62), att vara arbetslös eller sjukskriven (OR 2.58), och att ha barn (OR 2.0). Daglig tobaksanvändning var vanligt förekommande bland både kvinnor (33%) och män (50%), men vanligare bland dem med erfarenhet av upprepad abort (41%/57%). Konkreta åtgärder som kvinnor och män med aborterfarenhet efterfrågar i det förbyggande arbetet är fler arbetstillfällen, mer och bättre kvalitet på sexoch samlevnadsundervisningen i skolan, hög tillgänglighet till billiga och effektiva preventivmedel samt kvalificerad rådgivning. Slutsatserna i delarbete I och II är att kvinnor och män med erfarenhet av en abort löper hög risk för en upprepad abort. Personer med erfarenhet av upprepad abort är mer socioekonomiskt utsatta. Att minska skillnader mellan olika socioekonomiska grupper kan därför vara av betydelse i det förebyggande arbetet med oönskade graviditeter. Delarbete III syftade till att undersöka hur nöjda kvinnor och män upplevt vården i samband med en inducerad abort samt att identifiera faktorer som har samband med en hög grad av tillfredsställelse med vården. De flesta var nöjda med vården, men en fjärdedel (26%) av kvinnorna och nästan hälften av männen (48%) var inte helt nöjda. Den viktigaste faktorn för hög tillfredsställelse med vården var att ha fått ett gott bemötande bland både kvinnor (OR 11.78) och män (OR 5.32). Andra faktorer av betydelse var för kvinnorna att ha fått tillfredsställande; smärtlindring (OR 3.87), information om den gynekologiska undersökningen (OR 2.25), och preventivmedelsrådgivning (OR 2.23), samt att det var lätt nå kliniken via telefon (OR 1.91). För männen var även information om abortproceduren en viktig faktor för deras totala tillfredsställelse med vården (2.64). Slutsatserna i delarbete III är att en fjärdedel av kvinnorna och varannan man inte var helt nöjda, vilket indikerar att abortvården kan förbättras, speciellt avseende männen. Bland både kvinnor och män, är ett positivt bemötande från personalen den viktigaste faktorn för en tillfredsställande upplevelse av vården i samband med abort. Delarbete IV syftade till att undersöka förekomsten av existentiella tankar, känslor och handlingar bland 499 kvinnor som gjort en abort. Genom faktoranalys identifierades olika existentiella komponenter relaterade till en inducerad abort. Resultatet visade att sex av tio kvinnor hade existentiella tankar om livet, döden, mening och moral. Nästan hälften av kvinnorna uppgav att de hade behov att genomföra en symbolisk handling i relation till aborten, och 67% tänkte på fostret i termer av ett barn. Högre grad av existentiella faktorer korrelerade med större svårighet att fatta beslut om abort, och ett sämre psykiskt välbefinnande efter aborten. Slutsatserna i delarbete IV är att existentiella känslor, tankar och handlingar i samband med abort är vanligt förekommande. Detta är för vårdpersonalen en utmanande aspekt som inte självklart inkluderas i abortvården och dess styrdokument. Syftet med delarbete V, som var en kvalitativ studie, var att undersöka kvinnors och mäns upplevelser och behov i samband med hemabort. Syftet var även att belysa deras syn på samhälleliga åtgärder för att förebygga oönskade graviditeter. Kvinnorna rekryterades från fem olika kvinnokliniker och männen tillfrågades om att delta i studien genom kvinnorna. Tjugofyra kvinnor och 13 män intervjuades via telefon. Innehållsanalysen mynnande ut i två övergripande teman; autonomi som beskriver att beslutet om abort och valet av metod var väl genomtänkt av kvinnan, men oftast med stöd av partner. Hemmiljön ökade deras integritet och kontroll, vilket också underlättade deras möjligheter att fritt uttrycka och dela känslor; beroende som beskriver kvinnors och mäns önskan att bli behandlade med värdighet och respekt och att få tillfredsställande information som är individuellt anpassad för deras behov. Resultatet indikerar att hemabort ställer höga krav på vårdpersonalens kommunikationsförmåga. Kvinnor och män var motiverade att förebygga en ny oönskad graviditet men ett planerat återbesök var ovanligt. I det förebyggande arbetet av oönskade graviditeter ansågs fast arbete, förbättrad kommunikation/utbildning och subventionerade preventivmedel som viktigt. Slutsatserna i delarbete V är att hemabort ökar kvinnors och mäns autonomi, men samtidigt finns ett uttalat beroende av att vårdpersonalen utformar vården individuellt och med respekt för olika livssituationer. Rutiner och uppföljning bör därför kontinuerligt utvärderas för att säkerställa både kvaliteten av abortvården men också följsamheten i användningen av preventivmedel. Oönskade graviditeter och aborter är inte frågor som enbart berör kvinnor eller hälso- och sjukvården, det är större än så, ett delat ansvar som berör både individer och samhället.

In this thesis, I describe how women who are forced to migrate from Burma into Thailand manage their fertility, unwanted pregnancy and pregnancy loss. The study was initiated by Dr Cynthia Maung, a Burmese medical doctor, herself a stateless person who coordinates a refugee-led primary health service five kilometres inside Thailand. Unsafe abortion is a common problem and much time and resources are taken with the care of women suffering haemorrhage, infection and pain after self-induced abortion in both Thai and Burmese-led health facilities. The thesis examines the characteristics of Burmese women admitted to health facilities with post-abortion complications and their chosen methods of self-induced abortion. Local meanings of abortion and post-abortion care are explored. Lay midwives play a central role in fertility management and some are abortionists. Men’s role in the management of fertility is also presented. The women are generally married with children. Considered illegal migrants, they are employed and work in Thailand without work permits. Many women have a history of escaping human rights abuses and entrenched poverty in Burma. At least a third of women admitted into care with post-abortion complications had induced their abortion with oral herbal preparations, pummelling manipulations or stick abortions. Most of the abortion services were provided by Burmese lay midwives. Reasons for terminating the pregnancy include: poverty, gender-based violence and the local illness of ‘weakness’. In addition, low sexual health knowledge, and difficult access to reproductive health services play a part in mistimed pregnancy. / There is no commonly agreed definition of abortion between formal, informal health workers or women. Most people considered it against cultural lore and in some cases judicial law but still felt it was necessary. Women’s perceptions of the viability of their pregnancy and its outcome prevailed. Men played a limited role in fertility management. I argue that a lack of rights to work and earn a fair wage; to move without fear, a lack of sexual health information, and the ability to safely control fertility increases women’s risk of unsafe abortion. Furthermore, violence perpetrated at the individual and state level contributes to unsafe abortion. Burmese women’s mortality and morbidity associated with unsafe abortion is largely unrecorded by Thai processes and unknown to the Burmese military government. Unwanted and mistimed pregnancy can be avoided through reproductive technologies, education programmes, and access to modern contraceptives. To safely terminate unwanted pregnancies and to treat the complications of pregnancy loss is not only possible but a woman’s right as delineated in the international treaty CEDAW, to which Burma and Thailand are signatories. Yet Burmese women continue to suffer: become sterile, socially vilified, unemployed or repatriated against their will due to their reproductive status. Their sickness and deaths are secondary to the economic imperatives of Burma and Thailand and their human rights continue to be violated.....

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2010.

M.A. (Psychology) / Teenage pregnancies should be understood in terms of a changing of sexual behaviour, slowly evolving over many centuries. In contrast to our modern world, New England puritans in the seventeenth century demanded that the entire community conform to the exemplary moral codes drawn up by the first settlers. Civil magistrates or ministers were responsible for quickly and publicly chastised sexual offenders. One of the sources estimate that in the late 1670's well over one half of the guilty couples involved in premarital pregnancies found themselves convicted and punished. In England the loosening of the popular convention about sexual behaviour was followed by the restoration of the monarchy in 1660 as secularism replaced Puritanism. Observers noted steady but noticeable erosion of church and civil opposition to premarital sexual activity. In Essex County, the number of civil prosecutions dropped and the penalty ranged from corporal punishment to paying a fine. In Middlesex county, Massachusetts, signs of moral irresponsibility in fornication cases increased, starting in the 1660's (Vinovskis, 1988). When prominent church leaders such as Jonathan Edwards in the eighteenth century tried to punish the lax moral standards of their parishioners, they found they could no longer count on the support of their congregations and the rest of the community. Simultaneously with the unwillingness of the civil or church authorities to punish cases of pregnancies, parents gradually lost their ability to persuade their children to marry according to their parent's wishes. In the absence of concerted communal or familial efforts to curb the problem of teenage pregnancy, a general loosening of sexual behaviour occurred among early Americans. Sexual intimacy returned as a normal part of courtship behaviour and practices such as bundling became more common. The promise to marry rather than the marriage itself often led to sexual intercourse amongst couples. As long as the community was not burdened with the financial burden of illegitimate children, citizens tolerated premarital pregnancies. The result was not a breakdown of social mores in the early Republic but a shift in the definition of appropriate behaviour between individuals in love. Shorter (in Vinovskis, 1988) concludes that central in the history of courtship over the past two centuries had been the enormous increase in sexual activity before marriage. Before 1800 it was unlikely that the typical young woman, would have coitus with her partner and certainly not before an engagement had been sealed, and probably not as a fiancee either. After 1800 however the percentage of young women who slept with their boyfriends or fiancees rose steadily. Today it is a common phenomenon.

Although current professional and public opinion support the right of the client to make an informed decision about entering and continuing in a psychotherapy or counseling relationship, research studying the effects of informed consent on client behaviors and attitudes in the medical, research, and mental health fields has resulted in equivocal findings. This study looked at the effects of an informed consent procedure on client behaviors and attitudes in a pro-life pregnancy counseling center where the center's primary goal is to reduce the number of abortion decisions among clients. Thirty of the center's clients (Experimental Group) were given an Informed Consent Sheet that explicitly stated the center's policies, procedures, and goals while another 30 clients {Control Group) were exposed to the center's regular procedures which did not include this Informed Consent Sheet. Results of subsequently administered questionnaires showed that there were no differences between groups regarding their stated intention to abort a potential pregnancy, nor were there any differences between groups on their attitudes toward their counselors and their counseling experience, in general.