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.

Thesis advisor: Joellen W. Hawkins / African American women represent a unique group of women in the United States and have a long history of lack of reproductive freedom. Slavery and forced procreation, sterilization abuses, the Eugenics movement, and federally mandated contraception have all impacted on African American women’s independence in contraceptive decision-making. Given this population’s history, it is important for healthcare providers to understand African American women’s contraceptive decision-making, as women often seek their guidance. The purpose of this dissertation research was to discover the intergenerational influences on African American women’s contraceptive decision-making. The specific aims of this study were to: 1) develop an understanding of African American women’s contraceptive decision-making process; 2) identify the factors that influence their decision-making; and 3) develop knowledge that can be used to influence nursing practice. Included in this exploration were questions on the role of mothers and grandmothers in adolescents’ decision-making, familial beliefs about contraceptive choices and whether societal and social factors continue to influence contraceptive decisionmaking in the 21st Century. For this work, I used a qualitative descriptive approach to develop an understanding of the phenomenon from the participants’ worldview. I recruited a purposive sample of 7 triads from a metropolitan community in the northeast United States. I conducted an individual interview, using a semi-structured guide, with each participant. Six themes emerged from the data: 1) southern influences; 2) a worldview of relationships; 3) communication: key to preparedness; 4) seeking information from Mom; 5) "I got caught up in the game"; and 6) contraceptive use and beliefs. African American women's contraceptive decision making is influenced by a variety of factors including familial beliefs, attitudes, culture, and ethnicity. These patterns are transferred to each succeeding generation. Nurses have a significant role to play in providing appropriate contraceptive information and education in a culturally competent context that will meet the needs of these women and their families. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Por mais de trinta anos, a República de Angola esteve envolvida em uma guerra civil que gerou um impacto negativo no desenvolvimento nacional, na saúde e nutrição da população, especialmente de crianças e mulheres. Especificamente com relação à saúde da mulher, devido à guerra civil e à agitação política nos últimos anos, a literatura dispõe de dados pouco precisos sobre a situação da saúde da mulher angolana; porém as fontes disponíveis demonstram que as taxas de mortalidade materna e de fecundidade são elevadas. Considerando o contexto sócio- político-econômico atual e a prática assistencial em saúde disponibilizada às mulheres angolanas, torna-se evidente a necessidade de se analisar historicamente as políticas públicas relacionadas a esta área de atuação, no sentido de fornecer subsídios para que profissionais de saúde compreendam a importância das diretrizes políticas que devem ser seguidas na assistência à mulher angolana. Objetivos: o objetivo geral deste estudo é descrever o panorama histórico das políticas públicas voltadas à saúde da mulher em Angola, considerando o contexto político e econômico desde 1975 até a atualidade. Os objetivos específicos são contextualizar historicamente o período de análise; identificar os documentos relacionados às políticas de saúde da mulher em Angola; analisar os documentos identificados utilizando os preceitos da análise documental. Método: Trata-se de pesquisa de perspectiva histórica, utilizando a análise documental e análise categorial de dados históricos oficiais provenientes do Ministério da Saúde (MINSA), Direção Nacional de Saúde Pública (DNSP) e de site oficial da Organização Mundial da Saúde (OMS) no período de 1975 a 2012. Os documentos foram identificados, selecionados e obtidos durante o período de setembro a novembro de 2012, nos sites oficiais da OMS, UNICEF, e do Ministério da Saúde de Angola (MINSA) e alguns documentos foram solicitados diretamente à DNSP e MINSA, com o apoio do Instituto Superior de Enfermagem da Universidade Agostinho Neto. O corpus documental foi constituído de manuais, relatórios, boletim, leis e planos referentes à temática do estudo. Resultados: de acordo com a contextualização do período, a guerra prolongada impediu o desenvolvimento de um sistema de saúde adequado e, após a guerra, os investimentos voltados ao setor da saúde ainda não conseguiram estruturar uma rede de assistência que possa atender a toda a população. Com relação às políticas de saúde da mulher, destaca-se que estas se misturam com as políticas de saúde para a população, com investimentos suecos e de organismos internacionais que visavam a melhoria das condições de saúde da mulher e também da população em geral. As políticas e os acordos elaborados foram fortemente influenciados pela conjuntura mundial no período, apesar do aspecto cultural de desvalorização da mulher, tão presente no país. Houve uma grande dificuldade para a completa implementação das ações previstas, por inúmeros fatores, que vão desde as dificuldades geográficas e econômicas, até a adequada gestão política e financeira dos recursos. Considerações: evidencia-se que as necessidades de saúde das mulheres em Angola ainda não são completamente atendidas. Apesar dos esforços realizados durante o período, o desafio de Angola continua sendo a melhoria da prestação de cuidados de saúde, que engloba a saúde da mulher, e o aumento do acesso a serviços de qualidade a toda a população. A articulação inter-setorial também é necessária, pois pode potencializar as ações para a melhoria das condições de vida geral da população / For over thirty years the Republic of Angola was involved in a civil war that led to a negative impact on national development, in health and nutrition of the population, especially children and women. Specifically with regard to women\'s health, due to civil war and political unrest in recent years, the literature has little accurate data on the health situation of Angolan women; however the available sources demonstrate that rates of maternal mortality and fertility are high. Considering the current socio-economic-political context and assistance practice in health care available to Angolan women, it becomes evident the need to analyze historically public policies related to this area, in order to provide subsidies for health professionals understand the importance of the political guidelines that must be followed in assistance to Angolan woman. Objectives: The essential aim of this study is to describe the historical background of public policies for women\'s health in Angola, considering the political and economic context from 1975 to the present. The specific objectives are to contextualize historically the period of analysis, to identify the documents related to women\'s health policies in Angola; review the documents identified using the precepts of documentary analysis. Method: It\'s a survey of historical perspective, using documentary analysis and categorical analysis of official historical data from the Ministry of Health (MINSA), the National Public Health (DNSP) and the official website of the World Health Organization (WHO ) in the period between 1975-2012. The documents were identified, selected and collected during the period of September to November of 2012, at the official websites of WHO, UNICEF, and the Ministry of Health of Angola (MINSA) and some documents were requested directly to the DNSP and MoH, with support from the Higher Institute of Nursing, University Agostinho Neto. The documentary corpus consisted of manuals, reports, newsletter, laws and plans relating to the theme of the study. Results: According to the contextualization of the period, the prolonged war prevented the development of a proper health system and, after it, the investments directed to the health sector have failed to structure a support network that can meet the entire population\'s needs. Regarding to women\'s health policy, it is emphasized that these are mixed with health policies for the population, with Swedish and international organizations investments which aimed the improvement of the conditions of the women\'s health and also of the general population. The policies and agreements drafted were heavily influenced by the global conditions in the period, despite the cultural aspect of depreciation of women, strongly present in the country. There was a great difficulty for the complete implementation of the actions planned, for numerous factors, ranging from geographic and economic difficulties, to proper political and financial management of resources. Considerations: it is evident that the health needs of women in Angola haven\'t been completely met. Despite the efforts made during the period, the challenge of Angola remains being the improvement of health care provision, which includes women\'s health, and the enlargement of the access of quality services for the entire population. The intersectoral coordination is also necessary because it may increase the actions to improve the general living conditions of the population

Thesis (M.S.)--Boston University

In this study marital status and the alcoholism or non-alcoholism of the spouse are hypothesized to be important factors affecting the female alcoholic's personality and treatability.

African immigrant women and refugee women face disproportionate reproductive health risks and adverse outcomes compared with the Canadian population. The diversity of African women and complexity of the migration process suggest the need for contextualized knowledge to better understand these challenges. I sought such knowledge through the use of the theoretical frameworks of place and intersectionality. These frameworks draw attention to the multi-level mixture of social relations in given contexts and how they create opportunities and oppression. The specific purpose of this research was to: a) explore how the reproductive health experiences of African immigrant and refugee women were shaped by the unique context of given places; b) consider how these women actively negotiated and constructed place in their search for reproductive health information, services, and support. A multiple case study was used to explore the reproductive health experiences of African immigrant and refugee women in three different areas of Ottawa, Ontario. These areas provided different local contexts (e.g., history, socioeconomic profile, proximity to downtown). In each area, data was collected through interviews with African immigrant and refugee women, interviews and focus groups with reproductive health service providers, and mapping of available services. In total, 19 immigrant and refugee women and 23 service providers participated in this study. The findings showed that African immigrant and refugee women’s reproductive health experiences were much more complicated than simple interaction with neighbourhood services. Their varied social positions in Canadian society were highly relevant. In addition, social networks based in places outside of the system (e.g., private homes, religious institutions) were environments in which they were comfortable and sought support for their reproductive health needs. Recommendations based on these findings include the need to engage communities and explore the delivery of information and services outside of the traditional places employed by the Canadian health care system.

Chatelaine, Canada’s longest running women’s magazine (1928-present), has seen various changes in relation to women’s presence in society, specifically women’s health and bodies. The purpose of this study is to investigate the framing methods employed in the presentation of health content in relation to the evolution of feminism throughout this publication’s existence. Drawing upon Michel Foucault’s (1979; 1980) investigation of power, the body, and sexuality; Susan Bordo’s (1993b) feminist theorizing on the cultural meanings of the female body; Erving Goffman’s (1974) Frame Analysis; and further theoretical foundations of frame analysis by scholars in media and communication studies, this thesis examines the ways which health knowledge in Chatelaine aids in the empowerment and modernization of women. The research design of this thesis employs a quantitative media content analysis and qualitative semi-structured in-depth interviews to explore the presence and production of health content in this publication between 1928 and 2010. Findings demonstrate Chatelaine’s interaction with the feminist movement in Canada—as feminist initiatives and activism in Canada flourish, Chatelaine covers an increasingly broad and diverse body of health topics. The analyses reveal the sophistication in Chatelaine’s health content, which is evidenced in the employment of various journalistic techniques that aid in the development of an increasingly pervasive media text. In doing so, Chatelaine demonstrates its ability to empower women through current, clear, and concise health knowledge.

This dissertation combines the empowering methodology of photovoice with focus groups and in-depth interviews, to develop a contextual understanding of the meaning of breast cancer for Aboriginal women. Photovoice is a participatory action research method, as well as a process towards health promotion. The participants in this study took pictures to document their realities and engaged in critical reflection individually and in a group process, using images and stories to advocate community and policy changes. A combination of epidemiological, sociological, and anti-oppressive theoretical lenses were used to analyze the womens stories and data, which served to acknowledge heterogeneity, while integrating multiple social contexts.<p> The emerging framework revealed multi-faceted identities, commonalities of situation, and prominent social forces that affect identity and cancer experience. Interpretation of the womens stories and pictures resulted in four general themes: 1) adjusting to physical and psychological changes; 2) the need for culturally relevant sources of support; 3) shifting identities; and 4) personal and political advocacy/policy directions. Prominent social forces include: culturally derived meanings of identity and sexuality, cultural and historical experiences/traditions of Aboriginal peoples, racism and racial stigmas, and socio-economic inequalities. Breast cancer experiences are shown to be significantly linked to history and the impact of colonization and neo-colonialism. Findings also point to the importance of recognizing heterogeneity, which does not minimize the impact of colonial histories and oppression, but points to the importance of employing an anti-oppressive theoretical lens and research framework, able to handle complex intersecting social forces and multiple agencies. These findings provide support for using the photovoice methodology with Aboriginal women, especially for its ability to shift power from researchers to insiders, privilege Indigenous knowledges, and for providing opportunities for critical and multiple tellings. The dissertation concludes by introducing a governmentality lens, which questions whether photovoice methods can address the social and historical problems at the level of policy. This study directs our attention to the need for further research on: 1) the link between breast cancer experiences to historical, political, and social contexts of lives of Aboriginal peoples; and 2) the potential of photovoice methods to affect policy and social justice.

Evidence suggests that employment for women can reduce poverty and inequality resulting in improved living standards. The garment industry is an important source of income for Indian women. This thesis tested the effects of garment work as an income source on women’s health-care utilization practices and decision-making in comparison to both agricultural labourers and general women in India. Cross-sectional data collected from India’s National Family Health Survey-3 were used to generate descriptive statistics. Statistical modeling was used to test the effect of garment work on a) barriers to health care services and b) decision-making abilities of Indian women. Results suggest garment workers are younger, more educated, urban, and wealthier, make more cash earnings, and have more access and control over their own money as compared to agricultural labourers. Results indicate female garment workers report facing fewer barriers to accessing health care services. As well, access to cash earnings increases their decision-making abilities.

Chatelaine, Canada’s longest running women’s magazine (1928-present), has seen various changes in relation to women’s presence in society, specifically women’s health and bodies. The purpose of this study is to investigate the framing methods employed in the presentation of health content in relation to the evolution of feminism throughout this publication’s existence. Drawing upon Michel Foucault’s (1979; 1980) investigation of power, the body, and sexuality; Susan Bordo’s (1993b) feminist theorizing on the cultural meanings of the female body; Erving Goffman’s (1974) Frame Analysis; and further theoretical foundations of frame analysis by scholars in media and communication studies, this thesis examines the ways which health knowledge in Chatelaine aids in the empowerment and modernization of women. The research design of this thesis employs a quantitative media content analysis and qualitative semi-structured in-depth interviews to explore the presence and production of health content in this publication between 1928 and 2010. Findings demonstrate Chatelaine’s interaction with the feminist movement in Canada—as feminist initiatives and activism in Canada flourish, Chatelaine covers an increasingly broad and diverse body of health topics. The analyses reveal the sophistication in Chatelaine’s health content, which is evidenced in the employment of various journalistic techniques that aid in the development of an increasingly pervasive media text. In doing so, Chatelaine demonstrates its ability to empower women through current, clear, and concise health knowledge.