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  • Klingberg-Allvin, Marie, 1972-, et al. (författare)
  • Co-creation to scale up provision of simplified high-quality comprehensive abortion care in East Central and Southern Africa
  • 2018
  • Ingår i: Global Health Action. - 1654-9716 .- 1654-9880. ; 11:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Universal access to comprehensive abortion care (CAC) is a reproductive right and is essential to reduce preventable maternal mortality and morbidity. In East Africa, abortion rates are consistently high, and the vast majority of all abortions are unsafe, significantly contributing to unnecessary mortality and morbidity. The current debate article reflects and summarises key action points required to continue to speed the implementation of and expand access to CAC in the East, Central, and Southern African (ECSA) health community. To ensure universal access to quality CAC, a regional platform could facilitate the sharing of best practices and successful examples from the region, which would help to visualise opportunities. Such a platform could also identify innovative ways to secure women's access to quality care within legally restrictive environments and would provide information and capacity building through the sharing of recent scientific evidence, guidelines, and training programmes aimed at increasing women's access to CAC at the lowest effective level in the healthcare system. This type of infrastructure for exchanging information and developing co-creation could be crucial to advancing the Sustainable Development Goals 2030 agenda.
  • Påfs, J., et al. (författare)
  • Implementing the liberalized abortion law in Kigali, Rwanda : Ambiguities of rights and responsibilities among health care providers
  • 2020
  • Ingår i: Midwifery. - : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 80
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Rwanda amended its abortions law in 2012 to allow for induced abortion under certain circumstances. We explore how Rwandan health care providers (HCP) understand the law and implement it in their clinical practice. Design: Fifty-two HCPs involved in post-abortion care in Kigali were interviewed by qualitative individual in-depth interviews (n =32) and in focus group discussions (n =5) in year 2013, 2014, and 2016. All data were analyzed using thematic analysis. Findings: HCPs express ambiguities on their rights and responsibilities when providing abortion care. A prominent finding was the uncertainties about the legal status of abortion, indicating that HCPs may rely on outdated regulations. A reluctance to be identified as an abortion provider was noticeable due to fear of occupational stigma. The dilemma of liability and litigation was present, and particularly care providers’ legal responsibility on whether to report a woman who discloses an illegal abortion. Conclusion: The lack of professional consensus is creating barriers to the realization of safe abortion care within the legal framework, and challenge patients right for confidentiality. This bring consequences on girl's and women's reproductive health in the setting. Implications for practice: To implement the amended abortion law and to provide equitable maternal care, the clinical and ethical guidelines for HCPs need to be revisited. © 2019
  • Påfs, Jessica, 1984-, et al. (författare)
  • 'They would never receive you without a husband' : Paradoxical barriers to antenatal care scale-up in Rwanda.
  • 2015
  • Ingår i: ; 31:12, s. 1149-1156
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss').DESIGN: a study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda.FINDINGS: all informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in attending to ensure their partners' reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy.CONCLUSIONS: 'near-miss' women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications IMPLICATIONS FOR PRACTICE: these findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's and men's real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.
  • Graner, S., et al. (författare)
  • Pregnant women's perception on signs and symptoms during pregnancy and maternal health care in a rural low-resource setting
  • 2013
  • Ingår i: Acta Obstetricia Et Gynecologica Scandinavica. - 0001-6349 .- 1600-0412. ; 92:9, s. 1094-1100
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Women's understanding of pregnancy and antenatal care is influenced by their cultural context. In low-income settings women may have limited influence over their reproductive health, including when to seek health care. Awareness of signs of pregnancy complications is essential for timely care. The use of antenatal care services in Vietnam has been studied with quantitative methods but there are few qualitative studies on the perceptions of pregnancy and maternal health care among Vietnamese women. Design. Four focus group discussions with pregnant women were performed. Setting. The study was conducted in a rural district in northern Vietnam. Population. Pregnant women in the last trimester. Method. Manifest and latent content analysis. Result. The latent theme that emerged was a need for "securing pregnancy during its normal course and at deviation", consisting of the main categories "ensuring a healthy pregnancy" and "separating the normal from the abnormal". Conclusion. This qualitative study of pregnant women in rural Vietnam indicates how women create a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insight into pregnancy-related conditions was sought from various sources and influenced both by local traditions and modern medical knowledge. Public knowledge about different symptoms during pregnancy and a high confidence in maternal health care are the most likely contributing factors to the relatively good maternal health status in Vietnam.
  • Ivarsson, Anneli, et al. (författare)
  • Healing the health system after civil unrest
  • 2015
  • Ingår i: Global Health Action. - : Co-Action Publishing. - 1654-9716 .- 1654-9880. ; 8, s. 1-4
  • Tidskriftsartikel (övrigt vetenskapligt)
  • Larsson, Sofia, et al. (författare)
  • The discourses on induced abortion in Ugandan daily newspapers : a discourse analysis
  • 2015
  • Ingår i: Reproductive Health. - 1742-4755 .- 1742-4755. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Ugandan law prohibits abortion under all circumstances except where there is a risk for the woman's life. However, it has been estimated that over 250 000 illegal abortions are being performed in the country yearly. Many of these abortions are carried out under unsafe conditions, being one of the most common reasons behind the nearly 5000 maternal deaths per year in Uganda. Little research has been conducted in relation to societal views on abortion within the Ugandan society. This study aims to analyze the discourse on abortion as expressed in the two main daily Ugandan newspapers.Method: The conceptual content of 59 articles on abortion between years 2006-2012, from the two main daily English-speaking newspapers in Uganda, was studied using principles from critical discourse analysis.Results: A religious discourse and a human rights discourse, together with medical and legal sub discourses frame the subject of abortion in Uganda, with consequences for who is portrayed as a victim and who is to blame for abortions taking place. It shows the strong presence of the Catholic Church within the medial debate on abortion. The results also demonstrate the absence of medial statements related to abortion made by political stakeholders.Conclusions: The Catholic Church has a strong position within the Ugandan society and their stance on abortion tends to have great influence on the way other actors and their activities are presented within the media, as well as how stakeholders choose to convey their message, or choose not to publicly debate the issue in question at all. To decrease the number of maternal deaths, we highlight the need for a more inclusive and varied debate that problematizes the current situation, especially from a gender perspective.
  • Paul, Mandira, et al. (författare)
  • Negotiating collective and individual agency : a qualitative study of young women's reproductive health in rural India
  • 2017
  • Ingår i: Qualitative Health Research. - 1049-7323 .- 1552-7557. ; 27:3, s. 311-324
  • Tidskriftsartikel (refereegranskat)abstract
    • The societal changes in India and the available variety of reproductive health services call for evidence to inform health systems how to satisfy young women's reproductive health needs. Inspired by Foucault's power idiom and Bandura's agency framework, we explore young women's opportunities to practice reproductive agency in the context of collective social expectations. We carried out in-depth interviews with 19 young women in rural Rajasthan. Our findings highlight how changes in notions of agency across generations enable young women's reproductive intentions and desires, and call for effective means of reproductive control. However, the taboo around sex without the intention to reproduce made contraceptive use unfeasible. Instead, abortions were the preferred method for reproductive control. In conclusion, safe abortion is key, along with the need to address the taboo around sex to enable use of "modern" contraception. This approach could prevent unintended pregnancies and expand young women's agency.
  • Byrskog, Ulrika, et al. (författare)
  • Being a bridge : Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study
  • 2015
  • Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central. - 1471-2393 .- 1471-2393. ; 15:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.
  • Byrskog, Ulrika, et al. (författare)
  • Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden
  • 2014
  • Ingår i: BMC Public Health. - 1471-2458 .- 1471-2458. ; 14
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden.Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied.Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war.Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and
  • Iyengar, Kirti, et al. (författare)
  • "Who Wants to Go Repeatedly to the Hospital?" : Perceptions and Experiences of Simplified Medical Abortion in Rajasthan, India
  • 2016
  • Ingår i: Global qualitative nursing research. - : SAGE PUBLICATIONS INC. - 2333-3936. ; 3
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study is to explore women's experiences and perceptions of home use of misoprostol and of the self-assessment of the outcome of early medical abortion in a low-resource setting in India. In-depth interviews were conducted with 20 women seeking early medical abortion, who administered misoprostol at home and assessed their own outcome of abortion using a low-sensitivity pregnancy test. With home use of misoprostol, women were able to avoid inconvenience of travel, child care, and housework, and maintain confidentiality. The use of a low-sensitivity pregnancy test alleviated women's anxieties about retained products. Majority said they would prefer medical abortion involving a single visit in future. This study provides nuanced understanding of how women manage a simplified medical abortion in the context of low literacy and limited communication facilities. Service delivery guidelines should be revised to allow women to have medical abortion with fewer visits.
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