| 1. |
- Asamoah, Benedict Oppong, et al.
(författare)
-
Alcohol consumption in relation to maternal deaths from induced-abortions in Ghana
- 2012
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 9
-
Tidskriftsartikel (refereegranskat)abstract
- Introduction: The fight against maternal deaths has gained attention as the target date for Millennium Development Goal 5 approaches. Induced-abortion is one of the leading causes of maternal deaths in developing countries which hamper this effort. In Ghana, alcohol consumption and unwanted pregnancies are on the ascendancy. We examined the association between alcohol consumption and maternal mortality from induced-abortion. We further analyzed the factors that lie behind the alcohol consumption patterns in the study population. Method: The data we used was extracted from the Ghana Maternal Health Survey 2007. This was a national survey conducted across the 10 administrative regions of Ghana. The survey identified 4203 female deaths through verbal autopsy, among which 605 were maternal deaths in the 12 to 49 year-old age group. Analysis was done using Statistical software IBM SPSS Statistics 20. A case control study design was used. Cross-tabulations and logistic regression models were used to investigate associations between the different variables. Results: Alcohol consumption was significantly associated with abortion-related maternal deaths. Women who had ever consumed alcohol (ORadjusted 2.6, 95% CI 1.38-4.87), frequent consumers (ORadjusted 2.6, 95% CI 0.89-7.40) and occasional consumers (ORadjusted 2.7, 95% CI 1.29-5.46) were about three times as likely to die from abortion-related causes compared to those who abstained from alcohol. Maternal age, marital status and educational level were found to have a confounding effect on the observed association. Conclusion: Policy actions directed toward reducing abortion-related deaths should consider alcohol consumption, especially among younger women. Policy makers in Ghana should consider increasing the legal age for alcohol consumption. We suggest that information on the health risks posed by alcohol and abortion be disseminated to communities in the informal sector where vulnerable groups can best be reached.
|
|
| 2. |
- Kabakyenga, Jerome, et al.
(författare)
-
Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda
- 2011
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 8:33, s. 1-10
-
Tidskriftsartikel (refereegranskat)abstract
- Background Improving knowledge of obstetric danger signs and promoting birth preparedness practices are strategies aimed at enhancing utilization of skilled care in low-income countries. The aim was to explore the association between knowledge of obstetric danger signs and birth preparedness among recently delivered women in south-western Uganda. Methods The study included 764 recently delivered women from 112 villages in Mbarara district.Community survey methods were used and 764 recently delivered women from 112 villages in Mbarara district were included in study. Interviewer administered questionnaire were used to collect data. Logistic regression analyses were conducted to explore the relationship between knowledge of key danger signs and birth preparedness. Results Fifty two percent of women knew at least one key danger sign during pregnancy, 72% during delivery and 72% during postpartum. Only 19% had knowledge of 3 or more key danger signs during the three periods. Of the four birth preparedness practices; 91% had saved money, 71% had bought birth materials, 61% identified a health professional and 61% identified means of transport. Overall 35% of the respondents were birth prepared. The relationship between knowledge of at least one key danger during pregnancy or during postpartum and birth preparedness showed statistical significance which persisted after adjusting for probable confounders (OR 1.8, 95% CI: 1.2-2.6) and (OR 1.9, 95% CI: 1.2-3.0) respectively. Younger age and high levels of education had synergistic effect on the relationship between knowledge and birth preparedness. The associations between knowledge of at least one key danger sign during childbirth or knowledge that prolonged labour was a key danger sign and birth preparedness were not statistically significant. Conclusions The prevalence of recently delivered women who had knowledge of key danger signs or those who were birth prepared was very low. Since the majority of women attend antenatal care sessions, the quality and methods of delivery of antenatal care education require review so as to improve its effectiveness. Universal primary and secondary education programmes ought to be promoted so as to enhance the impact of knowledge of key danger signs on birth preparedness practices.
|
|
| 3. |
|
|
| 4. |
- Ny, Pernilla, 1969-, et al.
(författare)
-
Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partners involvement
- 2007
-
Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755 .- 1742-4755. ; 4:9
-
Tidskriftsartikel (refereegranskat)abstract
- Background Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner. Methods Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis. Results The four main categories that developed were: • Access to the professional midwife • Useful counselling • Stable motherhood in transition • Being a family living in a different culture Conclusion According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted. Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost. Clinical implications There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.
|
|
| 5. |
- Ny, Pernilla, et al.
(författare)
-
Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partners involvement
- 2007
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 4:1
-
Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner. METHODS: Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis. RESULTS: The four main categories that developed were:* Access to the professional midwife* Useful counselling* Stable motherhood in transition* Being a family living in a different culture CONCLUSION: According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted.Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost. CLINICAL IMPLICATIONS: There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.
|
|
| 6. |
|
|
| 7. |
- Hounton, Sennen, et al.
(författare)
-
Towards elimination of maternal deaths : maternal deaths surveillance and response
- 2013
-
Ingår i: Reproductive Health. - London : BioMed Central. - 1742-4755. ; 10, s. Article nr 1-
-
Tidskriftsartikel (refereegranskat)abstract
- Current methods for estimating maternal mortality lack precision, and are not suitable for monitoring progress in the short run. In addition, national maternal mortality ratios (MMRs) alone do not provide useful information on where the greatest burden of mortality is located, who is concerned, what are the causes, and more importantly what sub-national variations occur. This paper discusses a maternal death surveillance and response (MDSR) system. MDSR systems are not yet established in most countries and have potential added value for policy making and accountability and can build on existing efforts to conduct maternal death reviews, verbal autopsies and confidential enquiries. Accountability at national and sub-national levels cannot rely on global, regional and national retrospective estimates periodically generated from academia or United Nations organizations but on routine counting, investigation, sub national data analysis, long term investments in vital registration and national health information systems. Establishing effective maternal death surveillance and response will help achieve MDG 5, improve quality of maternity care and eliminate maternal mortality (MMR ≤ 30 per 100,000 by 2030).
|
|
| 8. |
- Johansson, Marianne, et al.
(författare)
-
Severe male infertility after failed ICSI treatment-a phenomenological study of men's experiences
- 2011
-
Ingår i: Reproductive Health. - : BioMed Central Ltd.. - 1742-4755. ; 8:4
-
Tidskriftsartikel (refereegranskat)abstract
- Background Male-factor infertility underlies approximately 30% of infertility in couples seeking treatment; of which 10% is due to azoospermia. The development of assisted reproductive technology (ART), enabling the use of epididymal or testicular sperm for fertilization of the partner's oocytes, has made biological fatherhood possible for men with obstructive azoospermia. There is limited knowledge of men's experience of their own infertility. The aim of this study was to describe men's experiences of obstructive azoospermia infertility. Methods Eight men with obstructive azoospermia, who had terminated Swedish public health system ART treatment two years previously without subsequent childbirth, were interviewed using a descriptive phenomenological method. Results The essence of the phenomenon is expressed with a metaphor: climbing a mountain step by step with the aim of reaching the top, i.e. having a child and thus a family with a child. Four constituents are included (1) inadequacy followed by a feeling of redress (2) marginalisation, (3) chivalry (4) extension of life and starting a family as driving forces. Conclusions Knowledge of men's experiences of their own infertility is important as a supporting measure to increase the quality of care of infertile couples. By adopting this facet of gender perspective in fertility treatment guidelines, care can hopefully be optimized.
|
|
| 9. |
|
|
| 10. |
- Ny, Pernilla, et al.
(författare)
-
Middle Eastern mothers in Sweden, their experiences of the maternal health
- 2007
-
Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; :4
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers’ experiences of the maternal health care services in Sweden and the involvement of their male partner. Methods: Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis. Results: The four main categories that developed were: • Access to the professional midwife • Useful counselling • Stable motherhood in transition • Being a family living in a different culture Conclusion: According to the respondents in this study, understanding the woman’s native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted. Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers’ earlier female network was often lost. Clinical implicationsThere is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner’s, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.
|
|
| 11. |
- Rööst, Mattias, et al.
(författare)
-
Social differentiation and embodied dispositions : a qualitative study of maternal care-seeking behaviour for near-miss morbidity in Bolivia
- 2009
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 6:1, s. Article ID: 13-
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundUse of maternal health care in low-income countries has been associated with several socioeconomic and demographic factors, although contextual analyses of the latter have been few. A previous study showed that 75% of women with severe obstetric morbidity (near-miss) identified at hospitals in La Paz, Bolivia were in critical conditions upon arrival, underscoring the significance of pre-hospital barriers also in this setting with free and accessible maternal health care. The present study explores how health care-seeking behaviour for near-miss morbidity is conditioned in La Paz, Bolivia.MethodsThematic interviews with 30 women with a near-miss event upon arrival at hospital. Near-miss was defined based on clinical and management criteria. Modified analytic induction was applied in the analysis that was further influenced by theoretical views that care-seeking behaviour is formed by predisposing characteristics, enabling factors, and perceived need, as well as by socially shaped habitual behaviours.ResultsThe self-perception of being fundamentally separated from "others", meaning those who utilise health care, was typical for women who customarily delivered at home and who delayed seeking medical assistance for obstetric emergencies. Other explanations given by these women were distrust of authority, mistreatment by staff, such as not being kept informed about their condition or the course of their treatment, all of which reinforced their dissociation from the health-care system.ConclusionThe findings illustrate health care-seeking behaviour as a practise that is substantially conditioned by social differentiation. Social marginalization and the role health institutions play in shaping care-seeking behaviour have been de-emphasised by focusing solely on endogenous cultural factors in Bolivia.
|
|
| 12. |
|
|
| 13. |
|
|
| 14. |
- Sydsjö, Gunilla, et al.
(författare)
-
Relationships in couples treated with sperm donation - a national prospective follow-up study
- 2014
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 11, s. 62-
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Long-term follow-up on relationship quality in couples who use sperm donation is scarce. Therefore, this study aimed to analyse changes over time in satisfaction with relationship in heterosexual couples who were scheduled for treatment with sperm donation and IVF couples treated with their own gametes and to compare the two groups undergoing different treatment for infertility. Method: A prospective follow-up study in which data were collected twice on two groups; couples receiving sperm donation and IVF couples using their own gametes. The ENRICH instrument was used to gain information about the individuals' subjective experience of their relationship at the time of acceptance for treatment and again 2-5 years later. Results: At the time of acceptance for treatment the men and women in the two groups assessed their relationships as being very solid on all dimensions and that there were no differences between the two groups. At the second assessment there was a decline in the satisfaction scores on the dimensions "Children and parenting" and "Egalitarian", while an increase in scores was observed on "Conception of life" and "Conflict resolution" both for men and woman and also for the two groups. For the couples that had a successful treatment and gave birth to a child/children there was a decrease in satisfaction of the relation in the sperm donation group as well as in the group of couples having IVF with own gametes. Conclusion: In conclusion, the overall quality of relationship is stable in couples receiving donated sperm and does not differ from couples undergoing IVF-treatment with own gametes.
|
|
| 15. |
- Sydsjö, Gunilla, et al.
(författare)
-
Relationships in oocyte recipient couples : a Swedish national prospective follow-up study
- 2014
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 11, s. 38-
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The long-term effect of treatment with donated oocytes on women's and men's perception of their relationship has been little studied. Thus the aim of this study was to analyse satisfaction with relationships in couples at the time of acceptance for treatment and 2-5 years after treatment with donated gametes and to compare them with IVF couples treated with their own gametes. Method: A prospective follow-up study in which data were collected twice on two groups; cohabitating couples receiving oocyte donation and cohabitating IVF couples using their own gametes. A standardised instrument, the ENRICH inventory, was used to gain information about the couples' subjective experience of their relationships. Results: At acceptance for treatment the couples in the two groups assessed their relationships as being very solid on all dimensions and that the women receiving treatment with oocyte showed a higher satisfaction compared to women treated with own gametes. For couples that did have a child, the group of women who had been through the oocyte donating program reported a better quality of their relationship than women in the control group. There were no significant differences in perceived relationship quality between men in the different groups, whether they had a child or not. Conclusions: From a long-term perspective couples using oocyte donation treatment have a balanced and solid view of their relationship and treatment, having children or not after treatment did not affect the nature of the relationships.
|
|
| 16. |
- Sydsjö, Gunilla, et al.
(författare)
-
Trends in caesarean section and instrumental deliveries in relation to Body Mass Index : a clinical survey during 1978 - 2001
- 2010
-
Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755. ; 7:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: During the last 20 years the rate of CS has increased in Sweden as it has in many other countries. The proportion of pregnant women suffering from a high BMI has also increased rapidly during the same time period. It would therefore be of interest to study both how and if these two observations are related to each other. The aim was therefore to study trends in mode of caesarean section (CS) and instrumental deliveries among women in three BMI groups over a time span of almost 25 years with special focus on the observed body weight of pregnant women.Method: The design is a retrospective cohort study using medical records of consecutively delivered women at two delivery wards in South East Sweden during the years 1978, 1986, 1992, 1997 and 2001.Results: No significant time-trends were found for CS and instrumental delivery within each BMI-group for the time period studied. The proportion of women with BMI >= 25 delivered by means of CS or instrumental delivery increased quite dramatically from 1978 to 2001 (chi(2) test for trend; p < 0.001 for both CS and instrumental deliveries). The mean birth weight in relation to BMI and year of study among women delivered by means of CS decreased, a trend that was most evident between 1997 and 2001 (F-test; p = 0.005, p = 0.004, and p = 0.003 for BMI < 20, 20-24.9, and >= 25, respectively).Conclusion: Overweight and obese pregnant women constitute a rapidly growing proportion of the total number of CS and instrumental deliveries. Planning and allocation of health resources must be adjusted to this fact and its implications.
|
|
| 17. |
- Yego, Faith, et al.
(författare)
-
A retrospective analysis of maternal and neonatal mortality at a teaching and referral hospital in Kenya
- 2013
-
Ingår i: Reproductive Health. - : Springer. - 1742-4755. ; 10, s. 13-
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To measure the incidence of maternal and early neonatal mortality in women who gave birth at Moi Teaching and Referral Hospital (MTRH) in Kenya and describe clinical and other characteristics and circumstances associated with maternal and neonatal deaths following deliveries at MTRH.METHODS: A retrospective audit of maternal and neonatal records was conducted with detailed analysis of the most recent 150 maternal deaths and 200 neonatal deaths. Maternal mortality ratios and early neonatal mortality rates were calculated for each year from January 2004 to December 2011.RESULTS: Between 2004 and 2011, the overall maternal mortality ratio was 426 per 100,000 live births and the early neonatal mortality rate (<7 days) was 68 per 1000 live births. The Hospital record audit showed that half (51%) of the neonatal mortalities were for young mothers (15-24 years) and 64% of maternal deaths were in women between 25 and 45 years. Most maternal and early neonatal deaths occurred in multiparous women, in referred admissions, when the gestational age was under 37 weeks and in latent stage of labour. Indirect complications accounted for the majority of deaths. Where there were direct obstetric complications associated with the delivery, the leading cause of maternal death was eclampsia and the leading cause of early neonatal death was pre-mature rupture of membranes. Pre-term birth and asphyxia were leading causes of early neonatal deaths. In both sets of records the majority of deliveries were vaginal and performed by midwives.CONCLUSION: This study provides important information about maternal and early neonatal mortality in Kenya's second largest tertiary hospital. A range of socio demographic, clinical and health system factors are identified as possible contributors to Kenya's poor progress towards reducing maternal and early neonatal mortality.
|
|
| 18. |
- Sydsjö, Adam, et al.
(författare)
-
Trends in induced abortion among Nordic women aged 40-44 years.
- 2011
-
Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755. ; 8:23, s. 1-5
-
Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Women aged 40-44 years in 2005 ought to have been subjected to much more influence on attitudes and knowledge on contraceptive methods during their fertile period than women who were in the same age span in 1975 when the abortion laws were introduced.MATERIAL: From official statistics, the rates of induced abortion and birth rates in women aged 40-44 years were collected for Sweden, Denmark, Norway and Finland for each five-year during the period 1975-2005.RESULTS: With the exception of Sweden all other studied Scandinavian countries have lowered their abortion rates since 1975 (p<0.001) and reduced the proportion of induced abortions in relation to birth rate (p<0.001). In 2005 these countries also had lower rates of induced abortion than Sweden in the age group 40-44 years (p<0.001).CONCLUSION: There is a significant change in rates of induced abortion in women aged 40-44 years in Finland, Norway, Denmark, and at status quo in Sweden. 40-44 years in Finland, Norway, Denmark, and at status quo in Sweden. This indicates that family planning programs works well in the Nordic countries. The differences found may be assumed to possible diverging focus on attitudes or ethical considerations.
|
|
| 19. |
- Houle, Brian, et al.
(författare)
-
The impacts of maternal mortality and cause of death on children's risk of dying in rural South Africa : evidence from a population based surveillance study (1992-2013)
- 2015
-
Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; 12:Suppl 1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Maternal mortality, the HIV/AIDS pandemic, and child survival are closely linked. This study contributes evidence on the impact of maternal death on children's risk of dying in an HIV-endemic population in rural South Africa. Methods: We used data for children younger than 10 years from the Agincourt health and socio-demographic surveillance system (1992-2013). We used discrete time event history analysis to estimate children's risk of dying when they experienced a maternal death compared to children whose mother survived (N=3,740,992 child months). We also examined variation in risk due to cause of maternal death. We defined mother's survival status as early maternal death (during pregnancy, childbirth, or within 42 days of most recent childbirth or identified cause of death), late maternal death (within 43-365 days of most recent childbirth), any other death, and mothers who survived. Results: Children who experienced an early maternal death were at 15 times the risk of dying (RRR 15.2; 95% CI 8.3-27.9) compared to children whose mother survived. Children under 1 month whose mother died an early (p=0.002) maternal death were at increased risk of dying compared to older children. Children whose mothers died of an HIV/AIDS or TB-related early maternal death were at 29 times the risk of dying compared to children with surviving mothers (RRR 29.2; 95% CI 11.7-73.1). The risk of these children dying was significantly higher than those children whose mother died of a HIV/AIDS or TB-related non-maternal death (p=0.017). Conclusions: This study contributes further evidence on the impact of a mother's death on child survival in a poor, rural setting with high HIV prevalence. The intersecting epidemics of maternal mortality and HIV/AIDS especially in sub-Saharan Africa - have profound implications for maternal and child health and well-being. Such evidence can help guide public and primary health care practice and interventions.
|
|
| 20. |
|
|
| 21. |
|
|
| 22. |
- Amroussia, Nada, et al.
(författare)
-
"Is the doctor God to punish me?!" : An intersectional examination of disrespectful and abusive care during childbirth against single mothers in Tunisia
- 2017
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 14
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Disrespectful and abusive treatment during childbirth is a violation of women's right to dignified, respectful healthcare throughout pregnancy and childbirth. Although reports point out that marginalized groups in society such as single mothers are particularly vulnerable to abusive and disrespectful care, there is a lack of in-depth research exploring single mothers' encounters at the maternal healthcare facilities, especially in Tunisia. In Tunisia, single mothers are particularly vulnerable due to their social stigmatization and socio-economic marginalization. This study examines the self-perceptions and childbirth experiences of single mothers at the public healthcare facilities in Tunisia.METHODS: This study follows a qualitative design. Eleven single mothers were interviewed in regard to their experiences with maternal healthcare services and their perceptions of the attitudes of the health workers towards them. The interviews also addressed the barriers faced by the participants in accessing adequate maternal healthcare services, and their self-perceptions as single mothers. The data were analyzed using an inductive thematic approach guided by the feminist intersectional approach. Emergent codes were grouped into three final themes.RESULTS: Three themes emerged during the data analysis: 1) Experiencing disrespect and abuse, 2) Perceptions of regret and shame attributed to being a single mother, and 3) The triad of vulnerability: stigma, social challenges, and health system challenges. The study highlights that the childbirth experiences of single mothers are shaped by intersectional factors that go beyond the health system. Gender plays a major role in constructing these experiences while intersecting with other social structures. The participants had experienced disrespectful and discriminatory practices and even violence when they sought maternal healthcare services at the public healthcare facilities in Tunisia. Those experiences reflect not only the poor quality of maternal health services but also how health system practices translate the stigma culturally associated with single motherhood in this setting. Social stigma did not only affect how single mothers were treated during the childbirth, but also how they perceived themselves and how they perceived their care.CONCLUSION: Ensuring women's right to dignified, respectful healthcare during childbirth requires tackling the underlying causes of social inequalities leading to women's marginalization and discrimination.
|
|
| 23. |
- Andersson, Christian, et al.
(författare)
-
The impact of a reproductive health voucher in Uganda using a quasi-experimental matching design
- 2024
-
Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- This study assesses the impact of a voucher project that targeted vulnerable and poor pregnant women in Uganda. Highly subsidised vouchers gave access to a package of safe delivery services consisting of four antenatal visits, safe delivery, one postnatal visit, the treatment and management of selected pregnancy-related medical conditions and complications, and emergency transport. Vouchers were sold during the project’s operational period from 2016 to 2019. This study covers 8 out of 25 project-benefiting districts in Uganda and a total of 1,881 pregnancies, including both beneficiary and non-beneficiary mothers. Using a matching design, the results show a positive effect on the survival of new-born babies. The difference in the survival rate between the control group and the treatment group is 5.4% points, indicating that the voucher project reduced infant mortality by more than 65 per cent. © The Author(s) 2024.
|
|
| 24. |
- Awasom-Fru, Adama, et al.
(författare)
-
Doctors' experiences providing sexual and reproductive health care at Catholic Hospitals in the conflict-affected North-West region of Cameroon : a qualitative study
- 2022
-
Ingår i: Reproductive Health. - : Springer Nature. - 1742-4755. ; 19:1
-
Tidskriftsartikel (refereegranskat)abstract
- Plain English Summary The main aim of this study was to explore doctors' experiences and perceptions of providing sexual and reproductive health care services at Catholic hospitals in a conflict affected area in Cameroon. In Cameroon, sexual, and reproductive health services are lacking, thereby contributing to a very high maternal mortality rate of about 456/100000 live births, far from the Sustainable Development Goal Agenda 2030. The Catholic Church remains one of the largest suppliers of health care services in Cameroon and receives huge funding from donors, but their role in providing sexual and reproductive health care is restricted by religious norms. This study therefore uses in-depth interviews with doctors from Catholic hospitals in the North-West region to explore their experiences in providing sexual and reproductive health services in a conflict region. Qualitative coding was done with NVivo, and data analysed using thematic analysis. The respondents described strict rules and a broad range of challenges to providing comprehensive sexual and reproductive health care services. Nonetheless, there is evidence of doctors overcoming obstacles to providing sexual and reproductive health (SRH) care despite the religious and political climate. However, while attempting to overcome challenges, participants describe numerous examples of poor SRH care and poor health outcomes. The study highlights the importance of understanding the intersect between religion and women's health, particularly in improving access to SRH for vulnerable populations in conflict affected areas. It further provides insight into doctors' motivations for practicing medicine, and how doctors cope and make efforts to provide care and minimize harm. Background Sexual and reproductive health (SRH) care services are essential to improving the lives of women and achieving the Sustainable Development Goals. In Cameroon, the Catholic Church is one the largest non-governmental suppliers of health care, but its role in providing SRH care is restricted by religious norms. Methods This study explored doctors' experiences and perceptions of providing SRH care at Catholic hospitals in a conflict-affected area in Cameroon by using 10 in-depth interviews with doctors from three Catholic hospitals in the North-West region. Qualitative coding was done with NVivo, and data were analysed using thematic analysis. Results Three themes and seven categories were identified. The respondents described strict rules and a broad range of challenges to providing comprehensive sexual and reproductive health care services. Nonetheless, there is evidence of doctors overcoming obstacles to providing SRH care despite the religious and political climate. However, whilst attempting to overcome challenges, participants described numerous examples of poor SRH care and health outcomes. Conclusion The study highlights the importance of understanding the intersect between religion and women's health, particularly in improving access to SRH for vulnerable populations in conflict-affected areas. It further provides insight into doctors' motivations in practicing medicine and how doctors cope and make efforts to provide care and minimize harm.
|
|
| 25. |
- Bakesiima, Ritah, et al.
(författare)
-
Modern contraceptive use among female refugee adolescents in northern Uganda : prevalence and associated factors
- 2020
-
Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; 17:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Adolescent pregnancies are persistently high among refugees. The pregnancies have been attributed to low contraceptive use in this population. The aim of this study was to determine the prevalence and factors associated with modern contraceptive use among female refugee adolescents in northern Uganda.METHODS: This was a cross sectional study using both descriptive and analytical techniques. The study was carried out in Palabek refugee settlement in Northern Uganda from May to July 2019. A total of 839 refugee adolescents who were sexually active or in-union were consecutively enrolled. Interviewer administered questionnaires were used for data collection.RESULTS: Modern contraceptive prevalence was 8.7% (95% CI: 7.0 to 10.8). The injectable was the most commonly used modern contraceptive method [42.5% (95% CI: 31.5 to 54.3)], and most of the participants had used the contraceptives for 6 months or less (59.7%). Reasons for not using modern contraceptives included fear of side effects (39.3%), partner prohibition (16.4%), and the desire to become pregnant (7.0%). Participants who were married (OR = 0.11, 95% CI: 0.04 to 0.35, p < 0.001), cohabiting (OR = 0.43, 95% CI: 0.20 to 0.93, p = 0.032) or having an older partner (OR = 0.93, 95% CI: 0.86 to 0.99, p = 0.046) were less likely to use modern contraceptives.CONCLUSION: Modern contraceptive use among female refugee adolescents was very low, and few reported a desire to become pregnant, leaving them vulnerable to unplanned pregnancies. Least likely to use modern contraceptives were participants who were married/cohabiting and those having older partners implying a gender power imbalance in fertility decision making. There is an urgent need for innovations to address the gender and power imbalances within relationships, which could shape fertility decision-making and increase modern contraceptive use among refugee adolescents.
|
|
| 26. |
- Begley, Cecily, 1954, et al.
(författare)
-
Respectful and disrespectful care in the Czech Republic: an online survey
- 2018
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 15
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Respectful maternity care includes treating women with dignity, consulting them about preferences, gaining consent for treatment, respecting their wishes, and giving care based on evidence, not routines. In the absence of any documented evidence, this study aimed to ascertain maternity care-givers' perceptions of respectful care provided for childbearing women in Czech Republic. Methods: Following ethical approval, an online quantitative survey with qualitative comments was completed by 52 respondents recruited from workshops on promoting normal birth, followed by snowball sampling. The majority were midwives (50%) or doulas (46%) working in one of 51 hospitals, or with homebirths. Chi-square analysis was used for comparisons. Results: Non-evidenced-based interventions, described as 'always' or 'frequently' used in hospitals, included application of electronic fetal monitoring in normal labour (n = 40, 91%), shaving the perineum (n = 10, 29%), and closed-glottal pushing (n = 32, 94%). Positions stated as most often used for spontaneous vaginal births were semi-recumbent (n = 31, 65%) or lying flat (n = 15, 31%) in hospital, and upright at home (n = 27, 100%). Average episiotomy and induction of labour rates were estimated at 40 and 26%, respectively, higher than accepted norms. Eighteen respondents (46%) said reasons for performing vaginal examinations were not explained to women in hospitals, and 21 (51%) said consent was 'never' sought. At home, 25 (89%) said reasons were explained, and permission always' sought (n = 22, 81%). Thirteen (32%) said hospital clinicians explained why artificial rupture of membranes was necessary, but only ten (25%) said they 'always' sought permission. The majority said that hospital clinicians 'never'/'almost never' explained reasons for performing an episiotomy (13 = 34%), gained permission (n = 20, 54%) or gave local anaesthetic (n = 19, 51%). Contrastingly, 17 (100%) said midwives at home explained the reasons for episiotomy and asked permission. When clinicians disagreed with women's decisions, 13 (35%) respondents said women might be told to 'face the consequences', six (16%) stated that the 'psychological pressure' experienced caused women to give up and 'give their permission', and four (11%) said the intervention would be performed 'against her will.' Conclusions: Findings reveal considerable levels of disrespectful, non-evidenced-based, non-consensual and abusive practices that may leave women with life-long trauma.
|
|
| 27. |
- Boene, Helena, et al.
(författare)
-
Obstetric fistula in southern Mozambique : a qualitative study on women’s experiences of care pregnancy, delivery and post-partum
- 2020
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 17
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Obstetric fistula is still common in low- and middle-income countries (LMIC) despite the on-going shift to increased facility deliveries in the same settings. The social behavioural circumstances in which fistula, as well as its consequences, still occur are poorly documented, particularly from the perspective of the experiences of women with obstetric fistula. This study sought to describe women’s experiences of antenatal, partum and post-partum care in southern Mozambique, and to pinpoint those experiences that are unique to women with fistula in order to understand the care-seeking and care provision circumstances which could have been modified to avoid or mitigate the onset or consequences of fistula.Methods: This study took place in Maputo and Gaza provinces, southern Mozambique, in 2016–2017. Qualitative data were collected through in-depth interviews conducted with 14 women with positive diagnoses of fistula and an equal number of women without fistula. All interviews were audio-recorded and transcribed verbatim prior to thematic analysis using NVivo11.Results: Study participants had all attended antenatal care (ANC) visits and had prepared for a facility birth. Prolonged or obstructed labour, multiple referrals, and delays in receiving secondary and tertiary health care were common among the discourses of women with fistula. The term “fistula” was rarely known among participants, but the condition (referred to as “loss of water” or “illness of spillage”) was recognised after being prompted on its signs and symptoms. Women with fistula were invariably aware of the links between fistula and poor birth assistance, in contrast with those without fistula, who blamed the condition on women’s physiological and behavioural characteristics.Conclusion: Although women do seek antenatal and peri-partum care in health facilities, deficiencies and delays in birth assistance, referral and life-saving interventions were commonly reported by women with fistula. Furthermore, weaknesses in quality of care, not only in relation to prevention, but also the resolution of the damage, were evident. Quality improvement of birth care is necessary, both at primary and referral level. There is a need to increase awareness and develop guidelines for prevention, early detection and management of obstetric fistula, including early postpartum treatment, availability of fistula repair for complex cases, and rehabilitation, coupled with the promotion of community consciousness of the problem.
|
|
| 28. |
|
|
| 29. |
- Chavula, Malizgani Paul, et al.
(författare)
-
Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries : a systematic review
- 2022
-
Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; 19:1
-
Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Comprehensive sexuality education (CSE) plays a critical role in promoting youth and adolescent's sexual and reproductive health and wellbeing. However, little is known about the enablers and barriers affecting the integration of CSE into educational programmes. The aim of this review is to explore positive and negative factors influencing the integration of CSE into national curricula and educational systems in low- and middle-income countries.METHODS: We conducted a systematic literature review (January 2010 to August 2022). The results accord with the Preferred Reporting Items for Systematic Reviews and Meta-analysis standards for systematic reviews. Data were retrieved from the PubMed, Cochrane, Google Scholar, and Web of Hinari databases. The search yielded 442 publications, of which 34 met the inclusion criteria for full-text screening. The review is guided by an established conceptual framework that incorporates the integration of health innovations into health systems. Data were analysed using a thematic synthesis approach.RESULTS: The magnitude of the problem is evidenced by sexual and reproductive health challenges such as high teenage pregnancies, early marriages, and sexually transmitted infections. Awareness of these challenges can facilitate the development of interventions and the implementation and integration of CSE. Reported aspects of the interventions include core CSE content, delivery methods, training materials and resources, and various teacher-training factors. Reasons for adoption include perceived benefits of CSE, experiences and characteristics of both teachers and learners, and religious, social and cultural factors. Broad system characteristics include strengthening links between schools and health facilities, school and community-based collaboration, coordination of CSE implementation, and the monitoring and evaluation of CSE. Ultimately, the availability of resources, national policies and laws, international agendas, and political commitment will impact upon the extent and level of integration.CONCLUSION: Social, economic, cultural, political, legal, and financial contextual factors influence the implementation and integration of CSE into national curricula and educational systems. Stakeholder collaboration and involvement in the design and appropriateness of interventions is critical.
|
|
| 30. |
|
|
| 31. |
- Christianson, Monica, et al.
(författare)
-
The advancement of a gender ethics protocol to uncover gender ethical dilemmas in midwifery : a preliminary theory model
- 2022
-
Ingår i: Reproductive Health. - : BioMed Central Ltd. - 1742-4755. ; 19:1
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Ethical dilemmas at both the individual and structural level are part of the daily work of midwives and gender inequality and injustice can affect women’s sexual and reproductive health. Mainstream bioethical theory has been criticized for neglecting women’s issues. To ensure women’s experiences are addressed, a gender lens on ethics is crucial. Aim: This study develops a theory model by exploring ethical dilemmas related to gender in the context of maternity care from the perspective of midwifery science and feminist ethics. Methods: The research strategy followed a coherent stepwise approach: literature search, thematic analysis, elaboration of a gender ethics protocol, and the integration of various components into a preliminary gender ethics model for midwifery. Findings: A literature search was performed using Scopus and Web of Science to identify ethical dilemmas in maternity care linked to gender and power. The search of articles published between 1996 and 2019 returned 61 abstracts. These abstracts were screened and assigned one of the following themes: The Midwifery Profession, The Rights of the Woman, Fetal Rights Dominate, and Medicalization of Pregnancy and Childbirth. A tentative gender ethics frame was developed and tested on two articles on abortion, one from Denmark and one from Japan. The protocol facilitated the gender analysis of ethical dilemmas related to abortion, which were related to the imbalance of power relations in health care. In the final step, we synthesized the dimensions of gender and power in a gender ethics model for midwifery. Discussion: The gender ethics protocol developed revealed gendered dimensions of ethical dilemmas in midwifery. This gender analysis adds to the understanding of the “do no harm” principle by revealing assumptions and stereotypes that promote unequal power relations. The gender ethics model is an innovative approach that envisions and exposes power imbalance at the micro, meso, and macro levels. Conclusions: The protocol could improve gender competence among researchers, midwives/professionals, and midwifery students throughout the world.
|
|
| 32. |
- Dahlberg, Johan, et al.
(författare)
-
Fecundity and human birth seasonality in Sweden : a register-based study
- 2019
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 16
-
Tidskriftsartikel (refereegranskat)abstract
- Background: It is well-established that couples' fecundities vary widely. Each couple has a relatively constant monthly probability of conceiving, which can vary from zero to quite high. This underlying probability is usually expressed as the time (number of menstrual cycles) the couple requires to conceive. Couples with high fecundity will, on average, need fewer cycles than couples with low fecundity. It is also well-documented that almost all human populations exhibit seasonal variation in births. Most European countries show seasonal variation that usually peak in the spring and are the lowest during the last quarter of the year. The increasingly strong pattern of depressed birth rates in November and December is likely explained by the December-January cut-off threshold for Swedish pupils' school entry and their parents increasing awareness of the negative effects on school outcomes for children who are juniors in the school-entry cohort they belong to. To actively plan births for a specific time of the year, couples need to have some knowledge of the time required for them to conceive.Methods: We use the duration between marriage of childless couples and first birth as a proxy measure of couples' fecundity. Based on this time-to-pregnancy measure we study to what extent couples' capacity to conceive affects the seasonality of their second births. We hypothesize that in a society with highly controlled fertility and a strong norm of having at least two children, sub-fertile couples will on average show less seasonal variation in second births. Sub-fertile couples, requiring more time to conceive the first time, will be less likely to try to target a desired birth month for their second child because doing so could jeopardize fulfilling their desired family size. We apply multinomial logistic regressions on 81,998 Swedish couples who married while being childless and subsequently gave birth to at least two children between 1990 and 2012, to investigate fecundity's role in seasonal variation in second births.Results: We found that seasonal variation in second births was strongly associated with couples' observed fecundity, measured as the duration between marriage formation and first birth. Our results support the hypothesis that sub-fertile couples, requiring more time to conceive the first time, show less seasonal variation in second births. The seasonal variations in second order births among couples with normal fecundity shows some similarities to traditional patterns as seen in agricultural and industrial societies of the past, with high numbers of births during the spring, and low numbers during the last quarter of the year. However, two important differences are notable. The characteristic Christmas peak in September has vanished, and the low birth rates in November and December come out much stronger than in the past.Conclusions: The birth seasonality among couples with normal fecundity are what we would expect if couples actively plan their births according to the cut-off date for Swedish pupils' school entry. We argue that our findings support the notion that scheduled childbirth is a reality in contemporary sociality.
|
|
| 33. |
- de Londras, F, et al.
(författare)
-
The impact of provider restrictions on abortion-related outcomes: a synthesis of legal and health evidence
- 2022
-
Ingår i: Reproductive health. - : Springer Science and Business Media LLC. - 1742-4755. ; 19:1, s. 95-
-
Tidskriftsartikel (refereegranskat)abstract
- Many components of abortion care in early pregnancy can safely be provided on an outpatient basis by mid-level providers or by pregnant people themselves. Yet, some states impose non-evidence-based provider restrictions, understood as legal or regulatory restrictions on who may provide or manage all or some aspects of abortion care. These restrictions are inconsistent with the World Health Organization’s support for the optimization of the roles of various health workers, and do not usually reflect evidence-based determinations of who can provide abortion. As a matter of international human rights law, states should ensure that the regulation of abortion is evidence-based and proportionate, and disproportionate impacts must be remedied. Furthermore, states are obliged take steps to ensure women do not have to undergo unsafe abortion, to reduce maternal morbidity and mortality, and to effectively protect women and girls from the physical and mental risks associated with unsafe abortion. States must revise their laws to ensure this. Where laws restrict those with the training and competence to provide from participating in abortion care, they are prima facie arbitrary and disproportionate and thus in need of reform. This review, developed by experts in reproductive health, law, policy, and human rights, examined the impact of provider restrictions on people seeking abortion, and medical professionals. The evidence from this review suggests that provider restrictions have negative implications for access to quality abortion, contributing inter alia to delays and recourse to unsafe abortion. A human rights-based approach to abortion regulation would require the removal of overly restrictive provider restrictions. The review provides evidence that speaks to possible routes for regulatory reform by expanding the health workforce involved in abortion-related care, as well as expanding health workers' roles, both of which could improve timely access to first trimester surgical and medical abortion, reduce costs, save time, and reduce the need for travel.
|
|
| 34. |
|
|
| 35. |
|
|
| 36. |
- Eriksson, Catrin, et al.
(författare)
-
Quality of websites about long-acting reversible contraception : a descriptive cross-sectional study
- 2019
-
Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; 16:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Today, there are various short- and long-acting contraceptive alternatives available for those who wish to prevent unintended pregnancy. Long-acting reversible contraception are considered effective methods with a high user satisfaction. High-quality information about contraception is essential in order to empower individuals to reach informed decisions based on sufficient knowledge. Use of the Web for information about contraception is widespread, and there is a risk that those who use it for this purpose could come in contact with sources of low quality.OBJECTIVE: The overarching aim was to investigate the quality of websites about long-acting reversible contraception.METHODS: Swedish client-oriented websites were identified through searches in Google (n = 46 included websites). Reliability and information about long-acting reversible contraceptive choices were assessed by two assessors with the DISCERN instrument, transparency was analyzed with the Journal of the American Medical Association benchmarks, completeness was assessed with inductive content analysis and readability was analyzed with Readability Index.RESULTS: The mean DISCERN was 44.1/80 (SD 7.7) for total score, 19.7/40 (SD 3.7) for reliability, 22.1/35 (SD 4.1) for information about long-acting reversible contraceptive choices, and 2.3/5 (SD 1.1) for overall quality. A majority of the included websites had low quality with regard to what sources were used to compile the information (n = 41/46, 89%), when the information was produced (n = 40/46, 87%), and if it provided additional sources of support and information (n = 30/46, 65%). Less than half of the websites adhered to any of the JAMA benchmarks. We identified 23 categories of comprehensiveness. The most frequent was contraceptive mechanism (n = 39/46, 85%) and the least frequent was when contraception may be initiated following an abortion (n = 3/46, 7%). The mean Readability Index was 42.5 (SD 6.3, Range 29-55) indicating moderate to difficult readability levels, corresponding to a grade level of 9.CONCLUSIONS: The quality of client-oriented websites about long-acting reversible contraception is poor. There is an undeniable need to support and guide laypersons that intend to use web-based sources about contraceptive alternatives, so that they may reach informed decisions based on sufficient knowledge.
|
|
| 37. |
- Essen, Birgitta, et al.
(författare)
-
Is research data used in education for health professionals on management of Female Genital Cutting? : results from Sweden
- 2017
-
Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; 14
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction Since the 1980s, refugees have come to Sweden from the Horn of Africa, where the majority of women have undergone Female Genital Cutting (FGC). Sweden was the first country in the West to outlaw the practice in 1982, later it became illegal for a Swedish resident to perform FGC abroad. The Swedish government has allocated research funding and has put a lot of effort into prevention and management by means of writing guidelines and organized professional training activities for best practices of persons with FGMC. Methods We have explored to what extent empirical data from the international research field is used in professional education and policy documents from Swedish health authorities since the 1990s. We performed a systematic review of scientific papers, books, guidelines and grey literature reports from Sweden. We focus on outcomes related to maternity care (maternal, perinatal mortality) and youth health counselling (menstruation disorders, sexuality). Results The evidence-based knowledge from perinatal and maternal death audits had not been used in an appropriate way, basic medical knowledge on dysmenorrhea was neglected, and qualitative data on sexual health among women with FGC was not acknowledged in the documents. Conclusion Swedish authorities have worked to improve the health outcomes among women with FGC. However, evidence-based knowledge has been underused, thereby increasing the risk for harm in spite of good intentions.
|
|
| 38. |
|
|
| 39. |
- Fredriksson, Mio, 1976-, et al.
(författare)
-
Caesarean section on maternal request : a qualitative study of conflicts related to shared decision-making and person-centred care in Sweden
- 2024
-
Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundToday, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.MethodsA qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.ResultsIn the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process).ConclusionsThe complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context. Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.
|
|
| 40. |
- Gambadauro, Pietro, et al.
(författare)
-
Psychopathology is associated with reproductive health risk in European adolescents
- 2018
-
Ingår i: Reproductive Health. - : BMC. - 1742-4755. ; 15:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundReproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents.MethodsA structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded Saving and Empowering Young Lives in Europe (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions.ResultsOf 11,406 respondents (median age 15; interquartile range [IQR] 14-15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils 15years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors.ConclusionsThese findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.
|
|
| 41. |
- Gebreegziabher, Senedu Bekele, et al.
(författare)
-
Assessment of maternal and child health care services performance in the context of COVID-19 pandemic in Addis Ababa, Ethiopia : evidence from routine service data
- 2022
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 19:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In many settings, health care service provision has been modified to managing COVID-19 cases, and this has been affecting the provision of maternal and child health services. The aim of this study was to assess trends in selected maternal and child health services performance in the context of COVID-19 pandemic. Methods: A cross-sectional data review was conducted in Addis Ababa, Ethiopia from April to May 2021. Routine health management information system database was reviewed from Addis Ababa Health Bureau for the period from July 2019 to March 2021 across all quarters. Proportion and mean with standard deviation were computed. T-test was used to assess statistically significant differences in services mean performance. Results: Postnatal care visit, new contraceptives accepters, safe abortion care and number of under-5 years old children treated for pneumonia significantly decreased by 9.3% (p-value 0.04), 20.3% (p-value 0.004), 23.7% (p-value 0.01) and 77.2% (p-value < 0.001), respectively during the first 8 months of the COVID-19 pandemic compared to the previous 8 months’ average performance. The trends in Antenatal care first visit, new contraceptive accepters, pentavalent-3 vaccination and under-five children treated for pneumonia began to decline in January to March 2020, a quarter when the COVID-19 pandemic began; with accelerated declines in April to June 2020 following national lockdown. The trends for the stated services began to increase during July–September 2020, the last quarter of national lockdown. Contraceptive accepters and pentavalent-1 vaccination continued to decline and showed no recovery until January–March 2021 when this study was completed. Conclusions: Most of the maternal and child health services performance declined following the onset of COVID-19 pandemic and national lockdown, and most of the services began recovering during July–September 2020, the last quarter of national lockdown. However, new and repeat contraceptive accepters and pentavalent-1 recipients continue to decline and show no recovery during end of the study period. Implementing COVID-19 prevention measures and assuring the community about the safety of service delivery is imperative to ensure continuity of the maternal and child health services. Regular monitoring and evaluation of services performance is required to identify slowly recovering services and respond to potentially volatile changes during the COVID-19 pandemic.
|
|
| 42. |
|
|
| 43. |
|
|
| 44. |
- Johansson, Lydia, et al.
(författare)
-
Women’s experiences of dealing with fertility and side effects in contraceptive decision making : a qualitative study based on women’s blog posts
- 2023
-
Ingår i: Reproductive Health. - : BioMed Central (BMC). - 1742-4755. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Worldwide, there is limited knowledge regarding women’s views of future fertility in relation to contraceptive use. Few studies include material where women share their experiences at peer-written public domain websites, in spite of a larger portion of women discontinuing use of contraceptives. The objective of this study was to explore women’s experiences of contraceptive methods based on data gathered from individual blog posts. Methods: Explorative qualitative study including 123 individual blog posts as the data source analysed with inductive thematic analysis. Results: Two themes were identified. Theme 1, ‘Seeking control over reproduction and optimise fertility’ including the sub-themes; Having the possibility to decide if, and when, to become pregnant, The value of effective contraceptive methods and the impact of women’s sexuality, A wish to understand the body’s normal fertility function and Limited knowledge—sharing information about the menstrual cycle during counselling and Theme 2, ‘Making the complex decision on their own’ including the sub- themes; Limited or subpar guidance in counselling and need for information from social media, Relational and environmental factors influencing contraceptive decision making and Considering beneficial effects and fears of adverse health effects when using hormonal contraceptive methods. Conclusions: During counselling, women desired an extended dialogue regarding effectiveness, health effects of different methods and an increased understanding of their menstrual cycle. Insufficient understanding of contraceptive methods can lead to use of methods not providing the expected level of protection. Hormonal contraceptives, especially Long-acting reversible contraception (LARC) were believed to inhibit fertility long after ending treatment.
|
|
| 45. |
- Johnsdotter, Sara, et al.
(författare)
-
FGM alerts and expert assessments from healthcare providers : legal case analysis
- 2017
-
Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; 14:S2, s. 12-12
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Sweden legislated against FGM in 1982. Since then, nearly 90 suspected cases have reached the police and prosecutor. A few of the reports were alerts from healthcare professionals, but the bulk of them originated from daycare and social services sectors. Healthcare providers play a prominent role as experts in forensic investigations. Methods: Cases of suspected FGM originating from healthcare providers who have reported suspected, performed, or planned FGM were analylzed to determine the role of healthcare providers as experts in assessing whether FGM has been performed, and, if so, to what extent. Results: Very few cases analyzed had sufficient indictable evidence; two cases during 35 years were brought to court. The review revealed inconsistencies in the medical assessment processes during which medical experts reached divergent conclusions about FGM status. Conclusion: Variations in normal anatomy and also in cutting procedures make genital assessments by healthcare providers very difficult. It is of utmost importance that appropriate medical experts are summoned in FGM criminal investigations, since these processes often involve radical measures from the police and prosecutor, such as detention of legal custodians and compulsory medical genital examinations of young girls in order to obtain a legally valid medical certificate for an eventual court proceeding.
|
|
| 46. |
|
|
| 47. |
- Johnsdotter, Sara, et al.
(författare)
-
The increasing demand for reconstructive clitoral surgery among circumcised women living in Europe : A nexus analysis
- 2017
-
Ingår i: Reproductive Health. - : BioMed Central. - 1742-4755. ; 14:S2, s. 13-13
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: The demand for the surgical technique of clitoral reconstructive surgery introduced by Pierre Foldès is increasing globally despite lack of evidence of its benefits weighed against its potential harms. Methods: In an ongoing study, we use nexus analysis to study the introduction of the surgery in Sweden. In nexus analysis, one simultaneously reviews current discourses, actors and settings to understand a particular phenomenon. In this analysis we seek to determine who is promoting the surgery, in what settings, and what discourses are offered to interpret the phenomenon. Results: Preliminary results, in line with other studies from social science literature, suggest that reconstructive clitoral surgery as a biomedical practice is a response to Western discourses on ‘female genital mutilation’: discourses that label cut women as ‘mutilated’, sexually deprived and less feminine than uncut women. These discourses in themselves are harmful to women and may cause them to seek a surgical solution that may not actually lead to improved outcomes. Conclusion: A new biomedical surgical procedure has been introduced and is generally praised, despite the lack of evidence to prove beneficial outcomes. This surgery is embedded in a powerful discourse that may negatively affect far more women than those who opt for surgery. The negative effects of female genital cutting should be carefully addressed in campaigning in order not to stigmatize already cut women further.
|
|
| 48. |
|
|
| 49. |
|
|
| 50. |
- K.C, Ashish, 1982-, et al.
(författare)
-
Incidence of intrapartum stillbirth and associated risk factors in tertiary care setting of Nepal : a case-control study
- 2016
-
Ingår i: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 12
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Each year, 1.2 million intrapartum stillbirths occur globally. In Nepal, about 50% of the total number of stillbirths occur during the intrapartum period. An understanding of the risk factors associated with intrapartum stillbirth will facilitate the development of preventative strategies to reduce the burden of death. This study was conducted in a tertiary-care setting with the aim to identify the risk factors associated with intrapartum stillbirth.Methods: A case-control study was completed from July 2012 to September 2013. All women who had an intrapartum stillbirth during the study period were included as cases, and 20% of women with live births were randomly selected on admission to make up the referent population. Information from the clinical records of case and referent women was retrieved. In addition, interviews were completed with each woman on their demographic and obstetric history.Results: During the study period, 4,476 women with live births were enrolled as referents and 136 women with intrapartum stillbirths as cases. The following factors were found to increase the risk for intrapartum stillbirth: poor familial wealth quintile (Adj OR 1.8, 95% CI-1.1-3.4); less maternal education (Adj OR, 3.2 95% CI-1.8-5.5); lack of antenatal care (Adj OR, 4.8 95% CI 3.2-7.2); antepartum hemorrhage (Adj OR 2.1, 95% CI 1.1-4.2); multiple births (Adj. OR-3.0, 95% CI- 1.9-5.4); obstetric complication during the labor period (Adj. OR 4.5, 95% CI-2.9-6.9); lack of fetal heart rate monitoring per protocol (Adj. OR-1.9, 95% CI 1.5-2.4); no partogram use (Adj. OR-2.1, 95% CI 1.1-4.1); small weight for gestational age (Adj. OR-1.8, 95% CI-1.2-1.7); premature birth (Adj. OR-5.4, 95% CI 3.5-8.2); and being born premature and with small weight for gestational age (Adj. OR-9.0, 95% CI 7.3-15.5).Conclusion: Inadequate Fetal heart rate monitoring and partogram use are risk factors associated with intrapartum stillbirth and increasing the adherence to the interventions that can reduce the risk of intrapartum stillbirth. Preterm birth and small weight for gestational age were the factors that had the highest risk for intrapartum stillbirth, which indicates that adequate antenatal care can improve the health and growth of the baby and prevent premature death.
|
|
