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- Muganyizi, c, 1961-
(författare)
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Rape against Women in Tanzania : Studies of Social Reactions and Barriers to Disclosure
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis assessed responses toward rape against women as experienced by the victims and victim supporters in the context of the interaction between victims, supporters, and formal agencies in Tanzania. The overall research design was based on triangulation with a combination of qualitative and quantitative methods. A semi-qualitative study, in which free listings and semi-structured questionnaires were used, explored social reactions from 44 community nurses and 50 rape victims (Paper I). A tool developed from this first study was utilized for collecting data on people’s attitudes and their behavior toward rape and rape victims from a representative community sample of 1505 men and women aged 18-65 years (Paper II). Both studies helped to access suitable rape victims and supporters who participated in the third study to share experiences on the process of rape disclosure to formal and informal social networks (Papers III and IV). The results highlighted the salient social reactions and how rape victims perceived the impact of these reactions. Half of the participants interpreted rape situations based on social relationships, circumstances, and social status of the woman, rather than the legal definition. Two-thirds of the adults explained they would express negative social reactions toward a victim in some rape scenarios, and this correlated with their attitudes towards rape and rape victims. A variety of barriers in the informal and formal networks with potentially negative impacts on rape reporting, service utilization and, health outcomes were identified. In conclusion, successful interventions aimed at improving people’s response to rape, rape disclosure and, health outcomes in Tanzania should assume a holistic approach to address the negative factors identified at the individual, family and, community levels without forgetting the normative context that appears to underlie most decisions and practice.
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| 2. |
- Georgsson Öhman, Susanne
(författare)
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Women's Experiences of Fetal Screening for Down's Syndrome by Means of an Early Ultrasound Examination
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to explore women's reactions to and experiences of fetal screening for Down's syndrome PS) by means of an ultrasound examination, including measurement of fetal nuchal translucency (NT). The effect of this screening on maternal worry about the baby's health was investigated, as well as reactions to a false positive test and interpretation of information about riskAlso, an instrument measuring worry during pregnancy, the Cambridge Worry Scale, was translated into Swedish and tested on a sample of pregnant women.A sub-sample of 2026 women was drawn from a larger randomised controlled trial including 39,572 women, which investigated medical outcomes of the new fetal screening policy. Of these women, 1030 were randomly allocated to the intervention group, and 996 to routine care. No statistically significant differences were found between the two groups regarding major worry about something being wrong with the baby, general anxiety and depressive symptoms m midpregnancy and two months postpartum.Twenty-four women who had received information about an increased risk according to NT were interviewed during pregnancy and after birth. Twenty of these women had false positive tests, and for 16 the risk was higher than expected considering their age. These women expressed major worry, and many said they chose to reject their pregnancy, to take "time out", while waiting for the results of fetal karyotyping. Two months after the birth, most of these women seemed to have overcome the stressful situation.In the intervention group of the above trial 796 women had a risk score for DS recorded in a clinical database. Of these women 620 said they had received information about the risk score, and 64 percent stated the figure almost correctly. The actual risk was associated with women's perception of the risk. Worry about the baby's health and depressive symptoms did not differ statistically between women who were at high risk (1:250 or higher) and at low risk. However, women who perceived that the risk was high were more worried about the baby's health and also seemed to have more depressive symptoms in mid-pregnancy compared with those who perceived the risk to be low. No differences were observed at two months after birth.The translated version of the Cambridge Worry Scale was tested on 200 Swedish pregnant women in Stockholm. The three main sources of worry were about the baby's health, giving birth and miscarriage. The internal- consistency reliability was 0.81 (Cronbach's alpha). Three items were added to the original scale to capture women's worry about the maternity services.In conclusion, the intervention with an early ultrasound examination including risk assessment for DS by measuring the NT did not affect maternal worry about the baby's health, general anxiety or depressive symptoms 'm mid-pregnancy or two months after birth. However, a false positive test could cause strong reactions of anxiety and rejection of the pregnancy for some weeks. Many had problems to recall and interpret a given risk score. An actual high risk score was not associated with major worry about the baby's health or depressive symptoms, whereas a woman's perception of being at high risk had such an association. The Swedish version of the Cambridge Worry Scale was considered to be useful and well suited for its purpose.
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| 3. |
- Wallin Lundell, Inger, 1958-
(författare)
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Induced Abortions and Posttraumatic Stress - Is there any relation? : A Swedish multi-centre study
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Induced abortion is a common medical intervention. Whether psychological sequelae might follow induced abortion has long been a subject of concern among researchers, and there is lack of knowledge about the relationship between posttraumatic disorder (PTSD) and induced abortion. Aims: To study and compare PTSD, posttraumatic stress symptoms (PTSS) and anxiety- and depressive symptoms among women seeking abortion, allowing for demographic variables. Further aims were to assess risk factors and to assess PTSD and PTSS following induced abortion in relation to experienced care at the clinic. Methods: This was a multi-centre cohort study targeting women who requested an induced abortion at the outpatient clinics of the gynaecology and obstetrics departments of six public hospitals in Sweden. All women who requested an induced abortion before the end of gestational week 12 were approached for participation. PTSD, PTSS, anxiety- and depressive symptoms, personality traits and women’s perceptions of abortion care were measured by means of questionnaires. Measurements were made at the first visit before the abortion as well as three- and six-months thereafter. Data collection was performed from September 2009 to January 2011. Results: 1,514 women filled out the questionnaire before the abortion. Abortion-seeking women did not suffer from PTSD to a greater extent than the general Swedish female population. Few women (51/720) developed PTSD or PTSS after the abortion, 11 did so due to trauma experience related to the abortion. Women at risk of posttraumatic stress were more likely to be young, having anxiety- or depressive symptoms and personality traits related to neuroticism. Furthermore, women with PTSD or PTSS were more likely to perceive certain aspects of the abortion care as deficient. Conclusions: The vast majority of women coped well with the induced abortion. Few developed posttraumatic stress post abortion. The majority did so because of trauma experiences unrelated to the induced abortion. Young women and women with mental distress are vulnerable groups that need to be paid attention to in abortion care. These women are at risk for negative experiences of the abortion care, and may be at risk of PTSD or PTSS post abortion
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| 4. |
- Ziaei, Shirin
(författare)
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Women’s status and child nutrition : Findings from community studies in Bangladesh and Nicaragua
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The importance of women’s status for child nutrition has recently been recognized. However, pathways through which women’s status can affect their caretaking practices and child nutrition have not been fully determined. The aim of this thesis was to evaluate associations between aspects of women’s status – including exposure to domestic violence and level of autonomy and social support – with their level of stress, feeding practices and child nutritional status in two different cultural settings: Bangladesh and Nicaragua.Data were acquired from population-based studies. For Study I we used data from the Bangladesh 2007 Demographic and Health Survey, and Study II was embedded in the 2009 Health and Demographic Surveillance System conducted in Los Cuatro Santos, rural Nicaragua. Studies III and IV were part of the MINIMat study, conducted in rural Bangladesh. In-person interviews were conducted and validated questionnaires were used in each of the studies. Anthropometric characteristics of the children were recorded based on standardized World Health Organization techniques.In Bangladesh, we found women with lifetime experience of domestic violence to be more likely to report emotional distress during pregnancy, cease exclusive breastfeeding before 6 months and have a stunted child. Further, we found a negative association between experience of domestic violence and duration of excusive breastfeeding to be mitigated with breastfeeding counseling. In Nicaragua, a lower level of maternal autonomy was associated with more appropriate breastfeeding practices such as higher odds of exclusive breastfeeding and longer continuation of breastfeeding. Further, a maternal lower level of social support was associated with better child nutritional status.In conclusion, this investigation showed that different dimensions of women’s status were associated with their feeding practices and child nutritional status and also revealed that the strength and direction of these associations may vary by the child’s age, setting and other contextual factors. These findings suggest that women’s status might have an important public health impact on child health and its role should be considered in programs and policies aiming to improve child health and nutrition.
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| 5. |
- Valladares Cardoza, Eliette, 1963-
(författare)
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Partner violence during pregnancy, psychosocial factors and child outcomes in Nicaragua
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objectives of the thesis was to explore partner violence during pregnancy in Nicaragua – its prevalence and characteristics, how women perceive, understand and cope with it, its association with specific child outcomes such as low birth weight (LBW), small for gestational age (SGA) and preterm birth, and possible pathways. A cross-sectional community-based study was conducted with 478 pregnant women and for a sub-sample of 147 salivary cortisol was measured. A case-referent hospital-based study was organized including 303 mothers immediately after delivery. In-depth interviews were conducted with women survivors to increase understanding of partner violence during pregnancy. The prevalence of emotional, physical and sexual partner abuse during pregnancy was 32.4%, 13.4% and 6.7% respectively. Seventeen percent of the victims suffered all three types of violence and in two thirds the abuse was severe and repeated. Half of the abused women had experienced punches and kicks directed to the abdomen; however, only 14% had sought health care and very few had disclosed the abuse or contacted police or authorities. Adolescent mothers, unwanted pregnancy and late registration for antenatal care or no check-ups were more likely among victims. The access to social resources facilitated the women’s ability to cope with the abuse, but the pregnancy itself was a barrier to receiving support from family, friends or society. The ability to confront abuse was determined by a complex interplay of factors such as economic independence, severity of abuse, access to social resources, implications for important others (i.e. children), socioeconomic group and a personal ability to cope with social norms. Low social resources, high levels of emotional distress and attempted suicide were associated with violence during pregnancy. Abuse during pregnancy was also found as an independent risk factor for LBW. Sixteen percent of LBW was attributed to physical abuse by a partner during pregnancy. A significant association between abuse during the index pregnancy and SGA was found. Partner violence during the pregnancy, low social resources and emotional distress were associated with higher levels of salivary cortisol. Pregnant women with high cortisol values were significantly more likely to give birth to SGA babies. A substantial decrease of birthweight, 142 grams, was estimated to be associated with increases in cortisol due to violence exposure. Partner violence during pregnancy is a serious social problem that impacts the rights, health and wellbeing of both the woman and her unborn child. The studies call for prioritization of intervention programmes for prevention and detection of violence, treatment and rehabilitation of the victims and the perpetrators, and change of the structural causes producing violence in society.
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