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Sökning: WFRF:(Tydén Tanja 1949 )

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1.
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2.
  • Rydhstrom, Håkan, et al. (författare)
  • No relation between maternal weight gain and stillbirth
  • 1994
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 73:10, s. 779-781
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND. To evaluate the relationship between stillbirth in singleton pregnancy (> or = 28 weeks gestation) and maternal weight (weight gain) from 24 completed weeks. METHODS. All fetal deaths (n = 210) at five delivery units during seven years in southern Sweden were analysed. To each case a control mother was selected, the only matching criteria being parity and place of delivery. Regression analysis was used for comparison of body weight gain in cases and controls. RESULTS. Mothers experiencing stillbirth had a significantly lower mean body weight at 24 weeks gestation than control mothers (63.5 kg vs 67.3 kg; t = 2.4, p < 0.05). No significant difference between cases and controls was found in mean weight gain during pregnancy from 24 completed gestational weeks to delivery, even when the last three measurements before delivery for cases and controls were compared separately. CONCLUSION. There is no difference in body weight gain between mothers with stillbirth and mothers giving birth to a live infant.
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3.
  • Salih Joelsson, Lana, 1969-, et al. (författare)
  • Anxiety and depression symptoms among sub-fertile women, women pregnant after infertility treatment, and naturally pregnant women
  • 2017
  • Ingår i: European psychiatry. - : Cambridge University Press (CUP). - 0924-9338 .- 1778-3585. ; 45, s. 212-219
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundInfertility has been associated with psychological distress, but whether these symptoms persist after achieving pregnancy via assisted reproductive technology (ART) remains unclear. We compared the prevalence of anxiety and depressive symptoms between women seeking for infertility treatment and women who conceived after ART or naturally.MethodsFour hundred and sixty-eight sub-fertile non-pregnant women, 2972 naturally pregnant women and 143 women pregnant after ART completed a questionnaire in this cross-sectional study. The Anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A≥8) and Edinburgh Postnatal Depression Scale (EPDS≥12) were used for assessing anxiety and depressive symptoms, respectively. Multivariate Poisson regression models with robust variance were applied to explore associations with anxiety and depressive symptoms.ResultsThe prevalence of anxiety and depressive symptoms among sub-fertile, non-pregnant women (57.6% and 15.7%, respectively) were significantly higher compared to women pregnant after ART (21.1% and 8.5%, respectively) and naturally pregnant women (18.8% and 10.3%, respectively). History of psychiatric diagnosis was identified as an independent risk factor for both anxiety and depressive symptoms. The presence of at least one unhealthy lifestyle behavior (daily tobacco smoking, weekly alcohol consumption, BMI≥25, and regular physical exercise < 2 h/week) was also associated with anxiety (Prevalence Ratio, PR: 1.24; 95%CI: 1.09–1.40) and depressive symptoms (PR: 1.25; 95%CI: 1.04–1.49).ConclusionsWomen pregnant after ART showed no difference in anxiety and depressive symptoms compared to naturally pregnant women. However, early psychological counseling and management of unhealthy lifestyle behaviors for sub-fertile women may be advisable, particularly for women with a previous history of psychiatric diagnosis.
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4.
  • Salih Joelsson, Lana, et al. (författare)
  • Investigating the effect of lifestyle risk factors upon the number of aspirated and mature oocytes in in vitro fertilization cycles : interaction with antral follicle count
  • 2019
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 14:8
  • Tidskriftsartikel (refereegranskat)abstract
    • There is evidence demonstrating that certain lifestyle factors have a detrimental effect on fertility. Since such factors often coexist, possible synergistic effects merit further investigation. Thus we aimed to examine the cumulative impact of lifestyle factors on in vitro fertilization (IVF) early reproductive treatment outcomes and their interaction with measures of ovarian reserve. Materials and methods By following women who were starting their first fresh IVF cycle in 2 cohorts, the "Lifestyle study cohort" (hypothesis generating cohort, n = 242) and the "UppSTART study" (validation cohort, n = 432) in Sweden, we identified two significant risk factors acting independently, smoking and BMI, and then further assessed their cumulative effects. Results Women with both these risk factors had an Incidence Rate Ratio (IRR) of 0.75 [(95% CI 0.61-0.94)] regarding the number of aspirated oocytes compared to women without these risk factors. Concerning the proportion of mature oocytes in relation to the total number of aspirated oocytes, the interaction between BMI and Antral Follicle Count (AFC) was significant (p-value 0.045): the lower the value of AFC, the more harmful the effect of BMI with the outcome. Conclusions Data shows that there is an individual as well as a cumulative effect of smoking and BMI on the number of aspirated and mature oocytes in fresh IVF treatment cycles. AFC might modify associations between BMI and the proportion of mature oocytes in relation to the total number of aspirated oocytes. These results highlight the importance of lifestyle factors on IVF early reproductive outcomes and provide additional evidence for the importance of preconception guidance for the optimization of IVF cycle outcome. 
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5.
  • Salih Joelsson, Lana (författare)
  • Lifestyle and Reproductive Health among Women prior to Conception
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Health and lifestyle is of great importance when women intend to become pregnant, as well as during pregnancy. It is crucial that people seeking for infertility are aware of which lifestyle changes they can undertake to enhance the likelihood of treatment success. The overall aim of this project was to investigate the extent to which women comply with recommendations for lifestyle changes during the time they try to conceive and during early pregnancy and the impact of lifestyle risk factors on treatment results in sub-fertile women. Lifestyle factors and mental health at baseline and lifestyle changes women made while they were trying to conceive were assessed by a study-specific questionnaire. Both pregnant women and non-pregnant sub-fertile women in the mid-Sweden region were included. The level of pregnancy planning was associated with planning behavior. Only one-third of all pregnant women took folic acid one month prior to conception, 17% used tobacco daily and 11% used alcohol weekly three months before conception. In the sub-fertile non-pregnant women cohort, 13.2% used tobacco daily, 13.6% drank more than three cups of coffee per day, and 11.6% consumed more than two glasses of alcohol weekly. Among sub-fertile women, one-third were overweight or obese. Pregnant women who conceived with Assisted Reproductive Technology (ART) reported lower rates of anxiety and depression symptoms compared to sub-fertile women. They also showed no difference in depression and anxiety symptoms compared to women who conceived naturally. Among sub-fertile women undergoing their first IVF treatment cycle, an independent as well as a cumulative effect of smoking and BMI on the number of aspirated oocytes and the proportion of mature oocytes was observed, especially among women with low ovarian reserve. In conclusion, approximately half of the women in our studies retained habits with negative effects on fertility. This is worrying because the harmful consequences of negative lifestyle factors are well established. These negative lifestyle factors are easy to detect and adjust at an early stage in the assessment process and might allow for optimization of fertility treatment and pregnancy outcomes.
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6.
  • Walles, Bengt, et al. (författare)
  • Maternal health care program and markers for late fetal death
  • 1994
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 73:10, s. 773-778
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE. To identify markers for late fetal death, a multicenter study was performed, based on routinely obtained data from maternal health care units. MATERIAL AND METHODS. Prospectively recorded data were obtained from maternal health care units belonging to five delivery units. In all, 233 consecutive cases of singleton pregnancy involving late fetal death (> or = 28 weeks) were identified between 1983 and 1989. As a control for each case, the next consecutive mother giving birth to a live infant at the same delivery unit was selected, the sole matching criterium being parity. RESULTS. After exclusion of pregnancies with lethal malformations or trauma, 205 cases remained for the statistical analysis. Two main subgroups were identified: mothers with placental abruption (n = 44), and pregnancies with no obvious reason for fetal death (n = 101). An increased risk for late fetal death was evident in expectant mothers > or = 40 years (10 vs 1; chi 2 = 7.6, p < 0.01), and in smokers where an association was seen to placental abruption. A significantly increased risk was also seen in women with medical treatment for essential hypertension (8 vs 1; chi 2 = 5.6, p < 0.05). On the other hand, we found no correlation between proteinuria, glucosuria, decreasing symphysis-fundal height, or changes in the Hb, on the one hand, and late fetal demise, on the other. There was no overrepresentation of post dated pregnancy (by ultrasound early in the second trimester) among the cases. Nor did post dated pregnancies (> or = 42 weeks) estimated from first day of last menstrual period (but not post dated by ultrasound) imply a higher rate of fetal death, as has been suggested in previous studies. CONCLUSION. In the present material, there was no sign of systematic error in the evaluation of data routinely obtained from the antenatal clinics and maternity units. Apart from placental abruption in smokers, a high maternal age, and medical treatment for essential hypertension, deviating data were recorded as often among controls as among cases. No correlation was evident between a post date pregnancy and fetal demise. A short symphysis-fundal height was recorded as often among controls as among cases and the even distribution of fetal birthweight in case pregnancies around the standard curve for the normal population is noteworthy.
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7.
  • Aneblom, Gunilla, et al. (författare)
  • Knowledge, use and attitueds towards emergency contraceptive pills among Swedish women presenting for induced abortion
  • 2002
  • Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 109:2, s. 155-160
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To investigate the knowledge, experiences and attitudes towards emergency contraceptive pills (ECP) among women presenting for induced abortion. DESIGN: Survey by self-administered waiting room questionnaires. SETTING: Three large hospitals in the cities of Uppsala, Västerås and Orebro in Sweden. POPULATION: 591 Swedish-speaking women consecutively attending the clinics for an induced abortion during a four-month period in 2000. RESULTS: The response rate was 88% (n = 518). As many as 43% had a history of one or more previous abortions and 43% were daily smokers. Four out of five women, 83%, were aware of ECP, but only 15 women used it to prevent this pregnancy. Fewer, 38%, knew the recommended timeframes for use and 54% had knowledge of the mode of action. The two most common sources of information about ECP were media and friends. One out of five, 22%, had previously used the method, and at the time of conception, 55% would have taken ECP if it had been available at home, and 52% were positive to having ECP available over the counter. CONCLUSIONS: Emergency contraception is well known but is still underused. Lack of awareness of pregnancy risk may be one limiting factor for its use. Making ECP available over the counter may be an important measure towards better availability. Information strategies to the public are needed before ECP will be a widely used back-up method.
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8.
  • Bodin, Maja, et al. (författare)
  • Can Reproductive Life Plan-based counselling increase men's fertility awareness?
  • 2018
  • Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 123:4, s. 255-263
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Many men have limited knowledge about reproductive health and fertility. The aim of the study was to evaluate if Reproductive Life Plan (RLP)-based counselling during a sexual health visit could increase men’s fertility awareness.Material and methods: The study was a randomized controlled trial including 201 men aged 18–50 who visited either of two participating sexual health clinics in Sweden for sexually transmitted infection testing during 2014–2016. All men received standard care, and men in the intervention group (IG) also received oral and written RLP-based information about lifestyle and fertility. Awareness about fertility and lifestyle-related factors were the main outcomes, measured through a questionnaire before the intervention and through a telephone survey after three months. Impressions from the counselling were also assessed at follow-up.Results: A majority (71%) of men wanted children in the future. General fertility awareness increased from a mean score of 4.6 to 5.5 out of 12 (P = 0.004) in the IG. The mean number of accurate lifestyle factors (that could affect fertility) mentioned increased from 3.6 to 4.4 (P < 0.001) in the IG. There were no improvements in the control group. Among the men in the IG, 76% had a positive experience of the counselling, and 77% had received new information.Conclusion: The intervention managed to increase different aspects of men’s fertility awareness. In the future, the format for preconception care for men needs further development. Including men in preconception health policy guidelines and identifying suitable actors for care provision would be important first steps.
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9.
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10.
  • Bodin, Maja, et al. (författare)
  • Exploring men's pregnancy-planning behaviour and fertility knowledge : a survey among fathers in Sweden
  • 2017
  • Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 122:2, s. 127-135
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: Research about pregnancy-planning behaviour mostly focuses on women, even though pregnancy planning usually also concerns men. The purpose of this study was to investigate how men plan for family, and to measure their fertility knowledge after having become fathers.MATERIAL AND METHODS: Data were collected in 2014 as part of a Swedish longitudinal pregnancy-planning study. Men were recruited through their female partner one year after childbirth. Participants were asked to fill out a questionnaire about pregnancy planning, lifestyles, and fertility.RESULTS: Of the 796 participants, 646 (81%) stated that the pregnancy had been very or fairly planned, and 17% (n = 128) had made a lifestyle adjustment before pregnancy to improve health and fertility. The most common adjustments were to reduce/quit the consumption of alcohol, cigarettes, or snuff, and to exercise more. First-time fathers and those who had used assisted reproductive technology to become pregnant were more likely to have made an adjustment. Fertility knowledge varied greatly. Men with university education had better fertility knowledge than men without university education.CONCLUSION: Our findings indicate that there is variation in how men plan and prepare for pregnancy. Most men did not adjust their lifestyle to improve health and fertility, while some made several changes. Both pregnancy-planning behaviour and fertility knowledge seem to be related to level of education and mode of conception. To gain deeper understanding of behaviour and underlying factors, more research is needed.
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11.
  • Bodin, Maja, 1984- (författare)
  • To Plan or Not to Plan : Gender Perspectives on Pregnancy Planning, Fertility Awareness and Preconception Health and Care
  • 2018
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • The level of pregnancy planning is of importance to the well-being of parents and children. Unintended and/or unwanted pregnancies are often associated with less health promoting behavior during pregnancy, poorer health of the new born, and relationship dissatisfaction. Preconception care is a health service with the purpose to encourage people to become mindful about their reproductive intentions and raise fertility awareness, in order to maintain or improve reproductive health.Reproductive health is a highly gendered area, both due to biological conditions and social expectations on gender. In most cases, the focus of reproductive health and health promotion is on cis-women and their bodies. This thesis mainly focuses on persons self-identifying as men. The aim is to scrutinize the area of preconception health, investigate what pregnancy planning means to men and explore the relationship between pregnancy planning and fertility awareness.In Study I, 136 couples who attended their first antenatal visit answered questions about pregnancy planning. Most pregnancies were planned and couples had similar perceptions of the level of their planning. Study II describes pregnancy planning behavior and fertility knowledge among 796 recent fathers. Also in this study, most pregnancies were planned and 17% of the men had made at least one preconception lifestyle adjustment to improve health and fertility. Fertility knowledge varied greatly, although men with higher education demonstrated higher knowledge. Study III explores if Reproductive Life Plan-based counselling during a sexual health visit could increase men’s fertility awareness. The counselling had a moderate effect on participants’ fertility knowledge but managed to raise new thoughts about their own fertility, and was well received. Study IV follows up on the results from the first three studies, through in-depth interviews and focus group discussions with 25 men aged 23-49. Most participants took their fertility for granted. To cis-men in heterosexual relationships, the meaning of pregnancy planning usually meant taking the decision to try to become pregnant, and not much more. Trans-men and gay men where more invested in practical planning issues. In conclusion, this thesis shows how pregnancy planning is gendered, and that it is a more complex phenomenon than previously acknowledged.
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12.
  • Borneskog, Catrin, et al. (författare)
  • Changes in sexual behavior among high-school students over a 40-year period
  • 2021
  • Ingår i: Scientific Reports. - : Nature Research. - 2045-2322. ; 11:1
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to investigate sexual behavior, contraceptive use, risk factors as well as sources of sex information among first-year high-school students in Sweden. Secondly, to assess differences between genders and study programs as well as changes over a 40-year period. A repeated cross-sectional survey was conducted in two cities. A questionnaire comprising 77 items was used. The study population consisted of 415 students (63.4% females). The median age of sexual intercourse was 15 years. In total, 37% had had sexual intercourse, compared to 56.3% in 2009 and 45% in 1999 (p < 0.001), and the proportion of students who had their first sexual intercourse was not influenced by gender. More students in vocational programs (46.3%), compared to theoretical (33.3%), had experience of at least one sexual intercourse (p = 0.019). The same extend of contraception use at first and latest intercourse was reported, compared to previous studies. Forty-nine percent were mostly informed about sex from the internet, while in previous years, magazines, family and youth clinics were the main information sources. Comparing over time, students were in general less sexually experienced and less engaged in non-penetrative sex and physical intimacy. These findings call for a new approach, when designing sex and relationship education and health-care counseling in adolescents.
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13.
  • Carlander, Alisa, et al. (författare)
  • Unplanned pregnancy and the association with maternal health and pregnancy outcomes : A Swedish cohort study
  • 2023
  • Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 18:5
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: Unplanned pregnancies are common and associated with late initiation and inadequate antenatal care attendance, which may pose health risks to mother and child. How pregnancy planning relates to maternal health and delivery in Sweden, a country with free antenatal care and free abortion, has not been studied previously. Our aims were to study whether pregnancy planning was associated with antenatal care utilization and pregnancy outcomes in a Swedish setting.Methods: Data for 2953 women, who answered a questionnaire when recruited at antenatal clinics in Sweden and later gave birth, was linked to the Swedish Medical Birth Register. The degree of pregnancy planning was estimated using the London Measure of Unplanned Pregnancy. Unplanned (comprising unplanned and ambivalent intention to pregnancy) was compared to planned pregnancy. Differences between women with unplanned and planned pregnancy intention and associated pregnancy outcomes were analyzed using Fisher's exact test and logistic regression.Results: There were 31% unplanned (2% unplanned and 29% ambivalent) pregnancies, whereas most woman (69%) reported their pregnancy to be planned. Women with an unplanned pregnancy enrolled later to antenatal care, but there was no difference in number of visits compared with planned pregnancy. Women with an unplanned pregnancy had higher odds to have induced labor (17% versus 13%; aOR 1.33 95% CI 1.06-1.67) and a longer hospital stay (41% versus 37%; aOR 1.21 95% CI 1.02-1.44). No associations were found between pregnancy planning and pregnancy-induced hypertension, gestational diabetes mellitus, preeclampsia, epidural analgesia use, vacuum extraction delivery, Caesarean section or sphincter rupture.Conclusions :Unplanned pregnancy was associated with delayed initiation of antenatal care, higher odds for induction of labor and longer hospital stay, but not with any severe pregnancy outcomes. These findings suggest that women with an unplanned pregnancy cope well in a setting with free abortion and free health care.
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14.
  • Delbaere, Ilse, et al. (författare)
  • Fertility awareness and parenthood intentions among medical students in three European countries
  • 2021
  • Ingår i: European journal of contraception & reproductive health care. - : Taylor & Francis. - 1362-5187 .- 1473-0782. ; 26:4, s. 312-322
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: The aim of this study was to investigate medical undergraduate students' fertility awareness and parenthood intentions in three European countries, as well as possible differences across genders and countries.Materials and methods: A cross sectional survey among 656 medical students in Sweden, Belgium and Greece. The utilised questionnaire comprised 23 questions.Results: Three fourth of participants (n = 472/629) correctly stated that women are most fertile at 20-25 years of age. Approximately 91% correctly answered that women's fertility starts to significantly decline before the age of 35, which differed among countries of participation. Social oocyte or sperm freezing was considered by 67% of Belgians, 49% Greeks, and 16.5% Swedes (p < 0.001). Approximately 95% expressed a wish of having a child in the future and the median age was 29 years for the first and 35 years for the last child.Conclusions: Knowledge about fertility among medical students was in general satisfactory, albeit varying by country and gender. Medical curricula and social policies for childbearing should be respectively updated in EU countries suffering population growth.
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15.
  • Delbaere, Ilse, et al. (författare)
  • Knowledge about the impact of age on fertility : a brief review
  • 2020
  • Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 125:2, s. 167-174
  • Forskningsöversikt (refereegranskat)abstract
    • Delayed childbearing is currently a major challenge in reproductive medicine as increased age has an important impact on successful conception, both in natural and in assisted reproduction. There is a lack of knowledge about the impact of age on fertility, even in highly educated populations. A number of initiatives have been taken to increase fertility awareness. Health care providers have been encouraged to talk with patients about their reproductive life plan (RLP) for almost a decade based on recommendations from the Centres for Disease Control and Prevention. This concept has been explored successfully in Swedish contraception counselling. A growing number of online interventions aim to raise fertility awareness. These websites or interactive tools provide relevant information for individuals and couples as they consider whether they want children, when they should have them, and how many they may wish to have. These interventions are important, because research depicts that knowledge helps people in their decision-making process. With new fertility preservations such as egg freezing now available, additional education is needed to be sure that women and couples are well informed about the cost and low success rates of this intervention.
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16.
  • Ekstrand, Maria, et al. (författare)
  • Swedish teenager perceptions of teenage pregnancy, abortion, sexual behavior, and contraceptive habits : a focus group study among 17-year-old female high-school students
  • 2005
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 84:10, s. 980-986
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Sweden has the highest abortion numbers among the Nordic countries. Since 1995, the abortion rate among teenagers has increased by nearly 50%. We therefore undertook a study where the overall aim was to gain a deeper understanding on which factors female teenagers believe may explain the increasing numbers of teenage abortions. Teenagers' perceptions of teenage pregnancy, abortion, sexual behavior, and contraceptive habits were investigated. METHODS: Six focus group interviews with 17-year-old Swedish girls were conducted. The interviews were tape-recorded, transcribed verbatim, and analyzed by manifest content analysis. RESULTS: Negative attitudes toward teenage pregnancy and supportive attitudes toward abortion were expressed. Risk-taking behaviors such as negligence in contraceptive use and intercourse under the influence of alcohol were suggested as main reasons behind the increasing numbers of abortions among Swedish teenagers. The contemporary, sexualized, media picture was believed to influence adolescents' sexual behavior, and liberal attitudes toward casual sex were expressed. Girls were perceived as more obliged than boys in taking responsibility for contraceptive compliance and avoidance of pregnancy. The apprehension that hormonal contraceptives cause negative side-effects was widely spread, and the participants were found to have a somewhat limited knowledge of abortion. The majority were unsatisfied with the quality of sexual education provided by the schools. CONCLUSION: Possible reasons for increased abortion numbers among teenagers in Sweden could be liberal attitudes toward casual sex in combination with negligence in contraceptive use, use of alcohol followed by sexual risk-taking, fear of hormonal contraceptives, and a deterioration of sexual education in the schools.
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17.
  • Ekstrand Ragnar, Maria, et al. (författare)
  • Development of an evidence-based website on Preconception health
  • 2018
  • Ingår i: Upsala Journal of Medical Sciences. - : TAYLOR & FRANCIS LTD. - 0300-9734 .- 2000-1967. ; 123:2, s. 116-122
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Many women and men lack knowledge about fertility, including timing of the fertile window, age-related decline, and lifestyle factors that may impair fertility. The Internet has become an important source of information, but evidence-based information on fertility and reproduction in Swedish on the Internet is limited. The present study aimed to develop and evaluate an evidence-based fertility awareness website, 'reproduktivlivsplan.se', to increase awareness of fertility and provide guidance for improved preconception health and care among individuals and healthcare providers. Methods: The website's content, design, and layout were evaluated qualitatively among a total of 20 nursing students. An expert group of researchers also provided feedback on the content. Finally, healthcare providers (n = 24) answered a questionnaire covering attitudes and views on the Reproductive Life Plan website as a tool for counselling. Results: The developing process resulted in a mobile-friendly website, 'reproduktivlivsplan.se' (in English: Reproductive Life Plan). The website, including the content and layout, was positively evaluated by most participants and was amended according to suggested improvements. Uppsala University was found to be a trustworthy source. Conclusion: The evidence-based website 'reproduktivlivsplan.se' was well received among users and healthcare providers and may provide guidance for improved preconception health and care if it becomes well known and frequently used.
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18.
  • Gainer, Erin, et al. (författare)
  • Bringing emergency contraception over the counter : experiences of nonprescription users in France, Norway, Sweden and Portugal.
  • 2003
  • Ingår i: Contraception. - 0010-7824 .- 1879-0518. ; 68:2, s. 117-24
  • Tidskriftsartikel (refereegranskat)abstract
    • Emergency contraceptive pills are now available on a nonprescription basis in over 25 countries worldwide. In an effort to learn about women's experiences with this new means of emergency contraception (EC) service delivery, we conducted focus-group discussions with nonprescription EC users from France, Norway, Portugal and Sweden. Participants from these countries overwhelming supported pharmacy access to EC, explaining that pharmacy delivery facilitated rapid access to the method. Despite expressing mixed reviews of the counseling given by the providing pharmacists, participants reported that they knew how use the method safely and properly. Most indicated that the package insert was easy to understand and adequately answered the majority of their questions. Participants described the EC experience as a motivating factor that, in many cases, has led to more consistent use of regular contraceptive methods. These data are valuable to policy-makers and institutions interested in learning more about the safety and acceptability of nonprescription access to emergency contraceptive pills.
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19.
  • Gottvall, Maria, 1980-, et al. (författare)
  • Knowledge of human papillomavirus among high school students can be increased by an educational intervention
  • 2010
  • Ingår i: International Journal of STD and AIDS (London). - : SAGE Publications. - 0956-4624 .- 1758-1052. ; 21:8, s. 558-562
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to evaluate the effect of an educational intervention concerning human papillomavirus (HPV) directed at Swedish first year high school students. The intervention consisted of a class room lesson, a website and a folder. Outcome variables were knowledge of HPV and attitudes to preventive methods such as HPV vaccination, condom use and Pap smear testing. An intervention group (n = 92) was matched with two comparison groups (n = 184). At baseline, the median score for HPV knowledge was one out of 10 in both groups. At follow-up, the median knowledge score had increased to six in the intervention group, but was still one in the comparison group (P < 0.001). Attitudes to HPV vaccination, condom use and Pap smear testing remained the same (P > 0.05). In conclusion, a short school-based intervention can greatly increase the students' knowledge about HPV, but attitudes and behaviours are less easy to influence.
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20.
  • Grandahl, Maria, et al. (författare)
  • Catch-up HPV vaccination status of adolescents in relation to socioeconomic factors, individual beliefs and sexual behaviour
  • 2017
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:11
  • Tidskriftsartikel (refereegranskat)abstract
    • In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents' knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers' education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women's susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population.
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21.
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22.
  • Grandahl, Maria, et al. (författare)
  • ‘I also want to be vaccinated!’ – adolescent boys’ awareness and thoughts, perceived benefits, information sources, and intention to be vaccinated against Human papillomavirus (HPV)
  • 2019
  • Ingår i: Human Vaccines & Immunotherapeutics. - : Informa UK Limited. - 2164-5515 .- 2164-554X. ; 15:7-8, s. 1794-1802
  • Tidskriftsartikel (refereegranskat)abstract
    • This study investigates boys’ awareness and thoughts about human papillomavirus (HPV) and HPV vaccination, perceived benefits of vaccinating men, information sources and intention to be vaccinated against HPV. We used a qualitative approach and interviews were conducted with 31 upper secondary school male students. Two main themes 1) Promotion of equal health and 2) Increased knowledge facilitates the decision about HPV vaccination emerged from the analysis. The informants believed that it was important and fair to protect boys and girls equally against HPV. If HPV vaccination could prevent both girls and boys against an HPV-related disease, there was nothing to question or to discuss. It was not a matter of sex; it was a matter of equal rights. Moreover, an important reason for vaccinating boys was to prevent the transmission of the virus. However, the boys felt unsure and stated that they needed to know more. The school nurse and the school health were considered suitable both for distributing information and for providing the vaccinations.In conclusion, the participants were in favor of introducing HPV vaccination also for boys in the national vaccination program. Sex-neutral HPV vaccinations were viewed both as a way to stop the virus transmission and a means to promote equal health for the entire population.
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23.
  • Grandahl, Maria, et al. (författare)
  • Parents' knowledge, beliefs, and acceptance of the HPV vaccination in relation to their socio-demographics and religious beliefs : A cross-sectional study in Thailand
  • 2018
  • Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 13:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Thailand has one of the world's highest prevalence of cervical cancer, mainly caused by the human papillomavirus (HPV). HPV infections can successfully be prevented by vaccination, which is available at a cost but not yet implemented in the national vaccination program. Parents play a critical role in deciding whether to vaccinate their child against HPV. Thus, the aim was to examine the association between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. A cross-sectional design was used among three schools in Thailand: Nakorn Phatom province (suburban) and Bangkok (urban). Parents of 9-12-year-old daughters completed the questionnaires, guided by the Health Belief Model. In total, 359 parents completed the questionnaires; of those, 301 were included in the final analyses. The ordinary least squares (OLS) regression analysis showed that background knowledge of HPV and the HPV vaccine was positively related to knowledge of HPV and cervical cancer. For beliefs, knowledge was positively associated with susceptibility (i.e., parents' perceived risk of an HPV infection/related disease), severity, and benefit. However, knowledge was not significantly related to barriers. For acceptance, higher susceptibility and benefit were related to higher acceptance, and greater knowledge was associated with higher acceptance. Thus, we found associations between parents' knowledge, beliefs, and acceptance of the HPV vaccination for their daughters, considering their socio-demographics and religious beliefs. Parents, who reported religion as important, as opposed to those who did not, were more favorable toward the HPV vaccination. Four out of ten mothers had never undergone a cervical cancer screening, but most had accepted previous childhood vaccinations for their daughters. The overall acceptance of the vaccine was high, and we believe our results are promising for future implementation of the HPV vaccination in the national childhood vaccination program in Thailand.
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24.
  • Grandahl, Maria, et al. (författare)
  • School nurses' attitudes towards and experiences of the Swedish school-based HPV vaccination programme - A repeated cross sectional study
  • 2017
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:4
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to investigate school nurses' attitudes towards, and experiences of vaccination against human papillomavirus (HPV), and compare the results with a similar study three years earlier. School nurses (n = 736) from all counties in Sweden completed a questionnaire in spring 2016, four years after the implementation of the national HPV vaccination programme, and three years after the previous survey. Overall, the school nurses had more favourable attitudes towards the HPV vaccination programme compared to the study in 2013 (p = 0.015). More than half of the nurses (n = 415, 56%) strongly agreed that boys should also be offered the vaccine (p<0.001). There were no differences in school nurses' perceived knowledge about HPV in order to inform and to answer questions about the vaccine from the girls or from the parents. More than half of the nurses (n = 409, 56%) reported that they needed more education about HPV. Almost all nurses (n = 659, 90%) had been contacted by parents with questions about the vaccine, and most questions were related to vaccine safety. School nurses have a more favourable attitude towards the vaccination programme against HPV compared to three years earlier, although almost all nurses had been contacted by parents with diverse questions and concerns. The nurses believed that they needed more education about HPV. Thus, it is essential to provide ongoing education and training for school nurses who are key healthcare professionals for providing information about HPV and HPV vaccination to parents and to pupils.
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25.
  • Hviid Malling, Gritt Marie, et al. (författare)
  • ‘Doing it in the right order’ : childless men’s intentions regarding family formation
  • 2022
  • Ingår i: Human Fertility. - : Taylor & Francis Group. - 1464-7273 .- 1742-8149. ; 25:1, s. 188-196
  • Tidskriftsartikel (refereegranskat)abstract
    • In high-income countries, parental age at first birth has increased and this postponement increases the risk of involuntary childlessness or having fewer children than desired. This interview study was conducted in Denmark and Sweden among childless men (n = 29) in their last year of an education. The aim was to explore the role of individual and societal factors on fertility decision-making and men's reflections on barriers and enablers for earlier family formation. Data were analysed with thematic content analysis. Almost all participants wanted children in the future. Overall, there was a desire to follow the 'right chronology': get educated, having a stable relationship, employment and a good financial status before having children. While most men felt mature enough to have children, they were still not ready. Influences from within the inner social circle, societal expectations, the need for security and stability and being ready to give up freedom and individuality were factors that affected participants' preferred timing of parenthood. Most men did not have suggestions for how earlier family formation could be supported. Results suggest a gap between the ideal biological and ideal social age of family formation that may lead to unfulfilled parenthood aspirations.
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26.
  • Hviid Malling, Gritt Marie, et al. (författare)
  • Taking fertility for granted – a qualitative exploration of fertility awareness among young, childless men in Denmark and Sweden
  • 2020
  • Ingår i: Human Fertility. - : Taylor & Francis Group. - 1464-7273 .- 1742-8149. ; , s. 1-12
  • Tidskriftsartikel (refereegranskat)abstract
    • Most previous studies about fertility knowledge and attitudes among men have been based on quantitative methods using questionnaires with fixed-choice response options. The aims of this qualitative study were to explore childless young men’s reflections on fertility and infertility through semi-structured interviews. Danish (n = 17) and Swedish (n = 12) young childless men aged between 20 and 30 years in their last year of education were interviewed. Data were analysed using qualitative content analysis. Few informants had considered their own fertility, and most were positive towards fertility treatment. The young men had inadequate knowledge about factors that can potentially impair male and female fertility. On average, the young men each mentioned three different factors they believed influence male and female fertility: (i) health behaviour; (ii) factors beyond personal control; and (iii) age. None mentioned sexual transmitted infections (STIs) but most appeared aware of the effect of increasing age on fertility. The results of this study highlight the need for educational strategies to improve young men’s knowledge about fertility and the factors that influence it, particularly about the potential adverse effect of STIs on fertility.
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27.
  • Häggström-Nordin, Elisabet, et al. (författare)
  • Sexual behaviour and contraceptive use among Swedish high school students in two cities : Comparisons between genders, study programmes, and over time
  • 2011
  • Ingår i: European journal of contraception & reproductive health care. - London, United Kingdom : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 16:1, s. 36-46
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To investigate sexual behaviour and contraceptive use among first-year high school students in two Swedish cities in 2009, to compare male and female students, students in theoretical and vocational study programmes, and their sexual behaviour with that reported in 1979, 1989 and 1999. Methods In a cluster sample of 20 classes, students (N387), median age 16 years, completed a questionnaire consisting of 46 questions. Results More girls than boys had experienced petting (p≤0.003) and had received oral sex (p≤0.01). More boys than girls had masturbated (p≤0.0001) and watched pornography (p≤0.0001). The median age at first sexual intercourse was 15 years. Students in vocational programmes were more sexually experienced compared to their theoretical peers. The proportion of students having had sexual intercourse (p≤0.0002), and contraceptive use at first (p≤0.0001) and latest (p≤0.0001) sexual intercourse increased from 1979 to 2009. Alcohol use at first intercourse decreased over the period (p≤0.0001). Conclusion sGirls were more sexually experienced than boys, as were students in vocational programmes compared to their theoretical peers; this should be considered when tailoring sex education and counselling. Over time, an increase in students having had sexual intercourse, and contraceptive use at first and latest sexual intercourse was found.
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28.
  • Höglund, Anna T., 1960-, et al. (författare)
  • Knowledge of human papillomavirus and attitudes to vaccination among Swedish high school students
  • 2009
  • Ingår i: International Journal of STD and AIDS (London). - : SAGE Publications. - 0956-4624 .- 1758-1052. ; 20:2, s. 102-107
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of the study was to investigate knowledge of and attitudes to sexually transmitted infection (STI) and STI prevention with special focus on human papillomavirus (HPV) and the new vaccine against HPV, among 16-year-old high school students in a Swedish context. A study-specific questionnaire was distributed to 572 first year high school students from five different high schools in a medium-sized town in Sweden. The students lacked knowledge of HPV and its association with cervical cancer. Similarly, their knowledge of the new vaccine was limited. Their attitude to condom use when having sex with a new partner was positive, but decreased if oral contraceptives were used and if they were vaccinated against an STI. The main source of information was the school, followed by youth clinics and the media. The results highlight the clinical importance for school nurses and personnel at youth clinics to inform adolescents about HPV and its association with cancer.
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29.
  • Klanger, B, et al. (författare)
  • Sexual behavior among adolescents in Uppsala, Sweden.
  • 1993
  • Ingår i: Journal of Adolescent Health. - 1054-139X .- 1879-1972. ; 14:6, s. 468-74
  • Tidskriftsartikel (refereegranskat)abstract
    • The purpose of this study was to compare the sexual behavior of Swedish teenagers in the late 1980s with that in the late 1970s, when a similar study was performed in the same city. Another aim was to discover differences between boys and girls, smokers and nonsmokers, and pupils in theoretical and practical classes. A total of 383 high-school students answered a questionnaire about their sexual behavior, education, and attitudes. Almost one-half of the teenagers had already had intercourse. The median age at sexual debut was about 17 years. Among girls who had had intercourse, the median age at debut was lower than 10 years ago. A majority stated that their sexual behavior had been affected by the acquired immunodeficiency syndrome (AIDS) debate. This was, however, not clearly seen in their sexual behavior. Intercourse seemed to take place earlier in the relationship than 10 years ago, and the wish for more sexual experience had increased. The use of alcohol at the time of first intercourse had decreased significantly. Only 2% thought that they had too much sex education at school. As many as 41% felt they could not talk about sex with their parents. Efforts should be made both to enhance the quantity of sex education at school and to improve its quality. This might increase the chances of young people avoiding unwanted pregnancies and sexually transmitted diseases.
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30.
  • Koo Andersson, Melinda, et al. (författare)
  • Implementation of reproductive life planning (RLP) in primary health care supported by an evidence-based website
  • 2020
  • Ingår i: European journal of contraception & reproductive health care. - : TAYLOR & FRANCIS LTD. - 1362-5187 .- 1473-0782. ; 25:1, s. 1-7
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aims of the study were to evaluate how well the reproductive life plan (RLP) tool was implemented in practice and explore the utility of the website for patient counselling. Methods: A cross-sectional study was conducted in 2018, in which 73 midwives in primary health care were asked to use the RLP tool and the website in their daily practice. Three months later, participants answered a questionnaire, based on normalisation process theory (NPT), about their implementation experience. Results: The response rate was 73% (n = 53). The mean length of midwifery experience was 15 years. Almost all respondents (89%) reported a positive attitude towards the tool and the website and their ability to use them in practice. The majority agreed to all statements about implementation of the RLP, according to NPT. Use of the RLP also made it easier for midwives to support clients in forming reproductive goals (85%, n = 45), give family planning advice (81%, n = 43), give advice about how to improve health before pregnancy (85%, n = 45) and give advice about how to preserve fertility (89%, n = 47). Nine out of ten respondents said they would recommend the website to other midwives. Conclusion: The RLP was well implemented among the respondents and the majority considered the website to be a useful tool. Long-term studies are needed to further elucidate the effects of the RLP on changes in health behaviour and pregnancy outcomes.
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31.
  • Larsson, Margareta, 1950-, et al. (författare)
  • Do pregnant women want to know the sex of the expected child at routine ultrasound and are they interested in sex selection?
  • 2017
  • Ingår i: Upsala Journal of Medical Sciences. - : Taylor & Francis Group. - 0300-9734 .- 2000-1967. ; 122:4, s. 254-259
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of the study was to investigate if expecting parents wanted to know the sex of the fetus during ultrasound examination and if they had discussed it with the midwife. Another aim was to explore any interest in sex selection. Methods: A longitudinal survey in early and late pregnancy among 2393 women in Sweden. Results: Almost all (95.8%, n = 2289) women had discussed sex determination with the partner before the ultrasound scan, and 57% (n = 1356) of women and their partners wanted to find out the fetal sex. The expecting parents mostly initiated a discussion with the midwife (46%, n = 1088), but 10% (n = 229) stated that the midwives initiated the discussion. Few (5%, n = 118) expressed a potential interest in selecting sex of a baby. Women who were interested in sex determination did not differ from those who were not, with respect to age, origin, education, parity, level of pregnancy planning, or importance of religion, but women who had chosen another fetal diagnostic method were more interested in sex determination and in potential sex selection. Conclusions: Half of women and their partners wanted to know the fetal sex, and 5% were interested in sex selection. This high interest in sex determination is a challenge, since present national guidelines do not include sex determination as an option.
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32.
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33.
  • Liljas Stålhandske, Maria, 1970-, et al. (författare)
  • Choosing induced abortion : An existential event?
  • 2008
  • Konferensbidrag (refereegranskat)abstract
    • How do Swedish women cope with early induced abortion as a life event? This paper raises the issue of women’s existential needs in relation to abortion. Material from an ongoing empirical study, including interviews with women who have had an early abortion and personnel working in abortion care, will be presented. The study works out of a feministic perspective and aims at bringing a partly tabooed question connected to female reproductivity into the scholarly discussion. The aim is not to question the liberal abortion legislation in Sweden, which the author endorses. To make an induced abortion is to make a crucial decision. Current Swedish abortion research shows that the decision often comprises strong and conflicting emotions. For many women it means to go through a period where feelings of pride, desperation, relief, grief and emptiness succeed each other. At the same time abortion is not included among those life events that people normally share and manifest through religious and/or social rituals and traditions. The consequences of this for women’s existential wellbeing have not yet been studied in international research. The preliminary results of the study indicate that the need of existential and/or ritual processing is dependent upon the degree to which the woman experienced the abortion decision as difficult or ambivalent. When ritualizations of the event occur, they also seem to take different forms depending on how the woman relates to the aborted fetus.
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34.
  • Liljas Stålhandske, Maria, 1970-, et al. (författare)
  • Existential challenge in a secularized culture : abortion as a case
  • 2009
  • Konferensbidrag (refereegranskat)abstract
    • Outside the frames of both traditional religion and alternative therapies people in a secularized culture are still hit by life and death. Induced abortion can be one of these situations. How do Swedish women cope with abortion as a life event? This paper presents material from an on-going crossdisciplinary multicentre abortion study (here called MAS – Multicentre Abortion Study), involving both medical and humanistic departments at Uppsala University, and 13 hospitals in Sweden. The aim of MAS is to investigate men’s and women’s clinical as well as personal experiences in relation to abortion. MAS combines quantitative and qualitative methods, and theoretical perspectives from the psychology of religion as well as from the caring sciences and medicine. The purpose of the study is not to question the Swedish abortion legislation. This paper is based on one of the studies included in MAS. This study consists of qualitative interviews with twenty women who previously had had abortions. The aim was to explore experiences and acts that are significant for aborting women. The women were primarily recruited when visiting a student health centre in Uppsala. The study was designed on basis of the idea that it might be possible to detect movements relevant for religious studies by focusing on situations where people are more or less forced into the existential domain. These situations can bring forth examples of personal forms of meaning-making, significant for a time distinguished by religious privatization. In other words, the research presented here does not look at specificly religious activities, but a situation that existentially challenges the individual, in order to see how she handles this, where she seeks support, how she interprets the situation and expresses her sense of meaning. In Sweden, a pregnant woman is free to decide for abortion until the 19th week of gestation. However, over 90% of the abortions in Sweden are performed before gestation week 12. Induced abortions are widely accepted in the country and about every fourth pregnancy in Sweden is ended through abortion. Current Swedish abortion research shows that the abortion decision often comprises strong and conflicting emotions. For many women it means going through a period where feelings of pride, desperation, relief and grief succeed each other. At the same time abortion is not included among those life events that people share through religious and social ritual. The existential consequences of this situation for women’s wellbeing have not yet been systematically studied. The research presented here is a first attempt to fill this gap. Our preliminary findings suggest that abortion is experienced in a wide variety of ways. All women in the interview group, except one, are satisfied with the liberal Swedish abortion legislation, and several also express gratitude, when they compare the Swedish situation with more conservative countries. Many women also find the process easy to go through, and are most of all relieved when the unwanted pregnancy is ended. Others, however, find that the abortion initiates an existential journey. They describe processes that include thoughts and feelings around life and death, meaning, responsibility and guilt – combined with relief and gratitude. The stories from these women also underline the lack of possibilities for Swedish women to deal with the existential aspects of the abortion situation in a balanced way, let alone mark or end the abortion process through some form of symbolic act or ritualization. At a more general level, the results also highlight the growing need for existential awareness and education within the clinical milieu.
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35.
  • Liljas Stålhandske, Maria, 1970-, et al. (författare)
  • Necessary and impossible : On existential needs and expressions in relation to induced abortion
  • 2009
  • Ingår i: Welfare and Values in Europe.
  • Konferensbidrag (refereegranskat)abstract
    • How do Swedish women cope with induced abortion as a life event? Do existential and spiritual issues have anything to do with women’s psychological and existential wellbeing after an induced abortion? The paper presents material from a pilot study and an on-going crossdisciplinary study, involving the Institution of Women’s and Children’s Health and the Institution of Public Health at Uppsala University, exploring experiences and acts that are significant for aborting women. The purpose of the study is not to question the Swedish abortion legislation, but to investigate how individuals deal with existential experiences within a secularized context. The material includes interviews with women going through induced abortion. The project works out of a feministic perspective and aims at bringing a partly tabooed question connected to female reproductivity into the scholarly discussion. The study is designed on basis of the idea that it might be possible to detect movements relevant for religious studies by studying situations where people are more or less forced into the existential domain. In these situations, the idea is, it might be possible to detect those personal attempts at meaning-making that arise in a time distinduished by religious privatization and what has been called the subjective turn. Outside the frames of both traditional religion and alternative therapies people are still hit by life and death. In the absence of overarching spiritual references the individual is forced to make meaning out of the bits and pieces that lay at hand. Therefore, the research presented here does not look at specificly religious, spritiual or ritual activities, but a situation that existentially challenges the individual in order to see how she handles this, where she goes to find support, how she interprets the situation and expresses her sense of meaning. Early induced abortion is an incomplicated medical operation, and about every fourth pregnancy in Sweden is ended through abortion. At the same time a young, secularized woman who is grateful about the legal possibility to abort, can describe the abortion decision as beyond what ”really can be demanded of a human being”. Current Swedish abortion research shows that the decision often comprises strong and conflicting emotions. For many women it means to go through a period where feelings of pride, desperation, relief, grief and emptiness succeed each other. At the same time abortion is not included among those life events that people normally share and manifest through religious and social rituals and traditions. The consequences of this for women’s existential wellbeing have not yet been studied in international research. The studies referred to in this paper is a first attempt to fill this gap. The preliminary findings suggest that abortion is experienced in a wide variety of ways, and that while many women find the process easy to go through, it initiates an existential journey for others.
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36.
  • Makenzius, Marlene, et al. (författare)
  • Women's decision-making related to induced abortion : a cross sectional study during a period of Covid-19 pandemic, in Sweden.
  • 2023
  • Ingår i: European journal of contraception & reproductive health care. - : Taylor & Francis Group. - 1362-5187 .- 1473-0782. ; 28:1, s. 44-50
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: To investigate women's decision-making on induced abortion.MATERIALS AND METHODS: A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion was measured using a 7-point Likert scale, and analysed with univariate and multivariate analysis (odds ratios [OR], 95% confidence intervals [CI]).RESULTS: About half (n = 322;52%) scored 1-4, suggesting the decision was perceived as easier compared to those (n = 292;48%) who scored 5-7. Reasons for the abortion were: poor economy (n = 166;27%), too early in the relationship (n = 154;25.1%), want to work first (n = 147;23.9%), want to study first (n = 132;21.5%), uncertain about the relationship (104;16.9%), and too young (n = 104;16.9%). Predictors for perceiving the decision as difficult: partner's hesitance (OR = 3.18, CI:1.76-5.73), being born outside the Nordic countries (OR = 2.23, CI:1.28-3.87), having discussed the decision with someone (OR = 2.42, CI:1.67-3.50), age ≥30 (OR = 2.22, CI:1.03-4.76), the Covid-19 pandemic (OR = 2.08, CI:1.20-3.59), and the desire to have children in the future (OR = 1.96, CI:1.18-3.28). After confirmed pregnancy, poor mental well-being was more common among those who scored 5-7 (n = 140;47.9%) compared to those who scored 1-4 (n = 122;37.9), p = .029.CONCLUSION: Women's decision-making on abortion is complex; in times of crises, the decision procedure may be even more difficult. This valuable knowledge could be used to improve and promote satisfactory counselling beyond medical routines.
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37.
  • Mattebo, Magdalena, 1976-, et al. (författare)
  • Pornography consumption and psychosomatic and depressive symptoms among Swedish adolescents: a longitudinal study
  • 2018
  • Ingår i: Upsala Journal of Medical Sciences. - : Taylor & Francis Group. - 0300-9734 .- 2000-1967. ; 123:4, s. 237-246
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aims of this longitudinal study were to identify predictors for continued pornography consumption and to investigate pornography consumption in relation to psychosomatic and depressive symptoms among a group of adolescents in Sweden.Methods and materials: A longitudinal study in classroom environment in 53 randomly selected senior high school classes in mid-Sweden in years 2011 and 2013. Out of 477 participating boys and 400 girls in 2011, 224 boys (47%) and 238 girls (60%) participated in 2013.Results: Higher pornography consumption at baseline and being born outside Sweden predicted continued pornography consumption at follow-up (adjusted R2 = 0.689).Psychosomatic symptoms at follow-up were predicted by higher pornography consumption at baseline (adjusted R2 = 0.254), being a girl, living with separated parents, and attending a vocational high school program. By contrast, depressive symptoms at follow-up were predicted by less pornography consumption at baseline (adjusted R2 = 0.122) and being a girl.Conclusions: Pornography consumption may, for some individuals, be associated to mental health issues. Differences between teenage boys and girls and between adolescents with diverse ethnic backgrounds imply that counseling and discussion about pornography need to be adjusted and individualized.
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38.
  • Niemeyer Hultstrand, Jenny, 1990- (författare)
  • Before Being Born : Studies on Preconception Health and Unplanned Pregnancies in Low- and High-Income Settings
  • 2021
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Nearly half of all pregnancies globally are unplanned. They represent a failure to meet individuals’ reproductive health needs and are associated with adverse maternal and child outcomes. Preconception and contraception care can help improving outcomes of pregnancies that are desired, and preventing those that are undesired. The aim of this thesis was to investigate factors that affect individuals and their children before they are born: parental preconception health and pregnancy planning. These phenomena were studied in Sweden and in Eswatini. Furthermore, a counseling tool to improve preconception care called the Reproductive Life Plan (RLP) was evaluated in Eswatini.In Sweden, baseline data from a cohort on pregnant women (n=3,389) of different origin were used. Many Nordic-born women drank alcohol (80% n=2,400) and smoked (20% n=607) preconception. Women born outside Europe were less likely to have these habits but more likely to have an unplanned pregnancy compared with Nordic-born women (AOR 1.37; 95% CI 1.01, 1.88).In Eswatini, data from client records were used (n=1,436). Seven out of ten pregnancies were unplanned (789/1,124). Adolescents had more than two-fold increased odds of unplanned pregnancy compared with women aged 20 or older (AOR 2.39; 95% CI 1.53, 3.75). Women with unplanned pregnancies were less likely to attend antenatal care (AOR 0.68; 95% CI 0.49, 0.95). We collected qualitative data on unplanned pregnancy using focus groups discussions (n=3) with health workers called mentor mothers (n=29). Unplanned pregnancies were thoroughly perceived as negative events with major social and health implications. Driven by poor socioeconomic conditions, young women often engaged in sexual relationships characterized by violence and gender inequality, resulting in unplanned pregnancies. These pregnancies often resulted in neglected children growing up to become vulnerable adolescents at risk of becoming pregnant unintendedly, thus generating a perpetuating cycle of unplanned childbearing.The RLP was used by the mentor mothers in client counseling (n=29). Focus groups discussions (n=7) and a questionnaire were used to collect data. The mentor mothers were key persons in implementing the RLP. Using this tool, they observed progress in pregnancy planning among their clients and thought it improved quality of contraceptive care. The clients' ability to form and achieve their reproductive goals was hindered by contextual factors such as intimate partner violence and limited reproductive health and rights.
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39.
  • Niemeyer Hultstrand, Jenny, et al. (författare)
  • Contraception use and unplanned pregnancies in a peri-urban area of eSwatini (Swaziland)
  • 2019
  • Ingår i: Sexual & Reproductive HealthCare. - : ELSEVIER IRELAND LTD. - 1877-5756 .- 1877-5764. ; 20, s. 1-6
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Despite reported high levels of contraception use in eSwatini, unplanned pregnancies are common. The aims of this study were to investigate prevalence and determinants of contraception use and unplanned pregnancies in a disadvantaged area in the Kingdom of eSwatini (Swaziland), and to investigate the association between unplanned pregnancies and antenatal care attendance. Methods: This cross-sectional study was conducted at the non-governmental organization Siphilile Maternal and Child Health in Matsapha, a peri-urban industrial area, using data from pre-existing client records. The sample included clients (n = 1436) registered during pregnancy or up to three months postpartum between August 2014 and April 2016. Contraception use before conception and unplanned pregnancies were analysed with logistic regression to find associations with socio-demographic factors and health care utilization. Results: In this population, 59% (n = 737) stated to have used contraception before becoming pregnant. Teenagers and first-time mothers were less likely to have used contraception. Seventy percent (789/1124) of the pregnancies were unplanned. Older women ( 35 years) were less likely while teenagers and multiparas (>= 3 children) were more likely to have an unplanned pregnancy. Women with unplanned pregnancies were less likely to attend the recommended number of antenatal care visits compared to women with planned pregnancies. Conclusion: The rate of unplanned pregnancies is high in this population, especially among teenagers. Family planning interventions need to focus on preconception care for teenagers to enable pregnancy planning including improved antenatal care attendance.
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40.
  • Niemeyer Hultstrand, Jenny, et al. (författare)
  • Contraceptive use among women seeking an early induced abortion in Sweden
  • 2023
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 102:11, s. 1496-1504
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: In spite of societal efforts to strengthen women's sexual and reproductive health in Sweden, many women have unmet contraceptive needs and the abortion rate remains high. The aim of this study was to investigate contraceptive use among abortion-seeking women. Material and methods: Swedish-speaking women seeking an induced abortion up to the end of gestational week 12 at seven hospitals filled out an anonymous paper questionnaire between January and June 2021. Data were analyzed using frequencies and cross-tabulations, and the Chi-square test was used to compare age-groups. Valid percentages are presented. Results: In total, 623 women participated. Median age was 29 years and 13% were born outside the Nordic countries. In the year preceding the abortion, condoms (37%, n = 228) were the most commonly used contraceptive method, followed by short-acting reversible contraception (SARC) (35%, n = 213) and withdrawal (25%, n = 152). Around one in five (n = 113) had not used any method in the year preceding the abortion. Sixteen percent (n = 96) had changed contraceptive method in the last year. At the time around conception, 15% (n = 90) reported use of SARC and 2% (n = 12) of long-acting reversible contraception (LARC). Four out of 10 women (n = 268) reported non-use of contraception at the time around conception, with a higher proportion among adolescents (70%, n = 30, P = 0.001). Among the women who responded to why they had not used any method (n = 387), the main reasons were that they did not believe they could become pregnant at that time (37%, n = 144) or had negative experiences from using contraceptives (32%, n = 123). A majority (88%, n = 527) planned to use contraception after the abortion. Of the women who had decided on method, 55% (n = 271) planned to use LARC, and 38% (n = 188) planned to use SARC. Conclusion: The unmet need for contraception appears to be high among abortion-seeking women in Sweden. Many had discontinued contraception use during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness, thus our recommendation would be to strengthen the sexual and reproductive knowledge among this group. 
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41.
  • Niemeyer Hultstrand, Jenny, et al. (författare)
  • Evaluating the implementation of the Reproductive Life Plan in disadvantaged communities : A mixed-methods study using the i-PARIHS framework
  • 2020
  • Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 15:9
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction The Reproductive Life Plan (RLP) is a clinical tool to help clients find strategies to achieve their reproductive goals. Despite much research on the RLP from high-income countries, it has never been studied in low- or middle income countries. Together with health workers called Mentor Mothers (MMs), we used a context-adapted RLP in disadvantaged areas in Eswatini. Our aim was to evaluate the implementation of the RLP in this setting. Methodology MMs participated in focus group discussions (FGDs, n = 3 MMs n = 29) in January 2018 and at follow-up in May 2018 (n = 4, MMs n = 24). FGDs covered challenges in using the RLP, how to adapt it, and later experiences from using it. We used a deductive qualitative thematic analysis with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, creating themes guided by its four constructs: facilitation, innovation, recipients and context. The MMs also answered a questionnaire to assess the implementation process inspired by normalization process theory. Results The RLP intervention was feasible and acceptable among MMs and fit well with existing practices. The RLP questions were perceived as advantageous since they opened up discussions with clients and enabled reflection. All except one MM (n = 23) agreed or strongly agreed that they valued the effect the RLP has had on their work. Using the RLP, the MMs observed progress in pregnancy planning among their clients and thought it improved the quality of contraceptive counselling. The clients' ability to form and achieve their reproductive goals was hampered by contextual factors such as intimate partner violence and women's limited reproductive health and rights. Discussion The RLP was easily implemented in these disadvantaged communities and the MMs were key persons in this intervention. The RLP should be further evaluated among clients and suitable approaches to include partners are required.
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42.
  • Niemeyer Hultstrand, Jenny, et al. (författare)
  • Foreign-born women’s lifestyle and health before and during early pregnancy in Sweden
  • 2020
  • Ingår i: European journal of contraception & reproductive health care. - : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 25:1, s. 20-27
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: The aims of the study were to investigate foreign-born women’s lifestyle and health before and during early pregnancy and compare them with those of Nordic-born women.Methods: Women recruited at antenatal clinics in Sweden answered a questionnaire in Swedish, English or Arabic or by telephone interview with an interpreter. Questions covered pregnancy planning and periconceptional lifestyle and health. The responses of women born in or outside Europe were compared with those of Nordic-born women. The impact of religiousness and integration on periconceptional lifestyle and health was also investigated.Results: Twelve percent of participants (N = 3389) were foreign-born (n = 414). Compared with Nordic women, European and non-European women consumed less alcohol before conception (respectively, adjusted odds ratio [aOR] 0.38; 95% confidence interval [CI] 0.24, 0.58 and aOR 0.14; 95% CI 0.10, 0.19) and during early pregnancy (respectively, aOR 0.61; 95% CI 0.40, 0.91 and aOR 0.20; 95% CI 0.14, 0.29). Non-European women used less tobacco and were less physically active, but body mass index (BMI) did not differ between groups. Self-perceived health, stress and anxiety during early pregnancy did not differ, but non-European women more often had depressive symptoms (aOR 1.67; 95% CI 1.12, 2.51). Non-European women’s healthy lifestyle was associated with religiousness but not with the level of integration.Conclusions: Non-European women were overall less likely to engage in harmful lifestyle habits before and during early pregnancy but were more likely to suffer from depressive symptoms in comparison with Nordic women.
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43.
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44.
  • Niemeyer Hultstrand, Jenny, et al. (författare)
  • The perpetuating cycle of unplanned pregnancy : underlying causes and implications in Eswatini
  • 2021
  • Ingår i: Culture, Health and Sexuality. - : Taylor & Francis. - 1369-1058 .- 1464-5351. ; 23:12, s. 1656-1671
  • Tidskriftsartikel (refereegranskat)abstract
    • Unplanned pregnancies constitute a major health problem globally carrying negative social, economic and health consequences for individuals and families. In this study, we explored the underlying causes and implications of this phenomenon in Eswatini, a country with high rates of unplanned pregnancy. Three focus group discussions were conducted in January 2018 with female health workers called mentor mothers, chosen because they offer a twofold perspective, being both Swati women and health workers in socially and economically disadvantaged settings. Using inductive thematic analysis, we identified five sub-themes and an overarching theme called 'the perpetuating cycle of unplanned pregnancy' in the data. A social-ecological model was used to frame the results, describing how factors at the individual, relationship, societal and community levels interact to influence unplanned pregnancy. In this setting, factors such as perceived low self-esteem as well as poor conditions in the community drove young women to engage in transactional relationships characterised by abuse, gender inequality and unprotected sex, resulting in unplanned pregnancy. These pregnancies led to neglected and abandoned children growing up to become vulnerable, young adults at risk of becoming pregnant unintendedly, thus creating an iterative cycle of unplanned childbearing.
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45.
  • Obern, C., et al. (författare)
  • Multiple induced abortions–implications for counselling and contraceptive services from a multi-centre cross-sectional study in Sweden
  • 2023
  • Ingår i: European journal of contraception & reproductive health care. - : Informa UK Limited. - 1362-5187 .- 1473-0782. ; 28:2, s. 119-124
  • Tidskriftsartikel (refereegranskat)abstract
    • Objectives: To investigate factors associated with multiple induced abortions. Materials and methods: A multi-centre cross-sectional survey among abortion-seeking women (n = 623;14-47y) in Sweden, 2021. ‘Multiple abortions’ was defined as having had ≥2 induced abortions. This group was compared to women with a previous experience of 0-1 induced abortion. Regression analysis was conducted to determine independent factors associated with multiple abortions. Results: 67.4% (n = 420) reported previous experience of 0-1 abortion, and 25.8% (n = 161) ≥2 abortions (42 women chose to not respond). Several factors were associated with multiple abortions, but when adjusted in the regression model, the following factors remained; parity ≥1 (OR = 2.96, 95%CI [1.63, 5.39]), low education (OR = 2.40, 95%CI [1.40, 4.09]), tobacco use (OR = 2.50, 95%CI [1.54, 4.07]) and exposure to violence over the last year (OR = 2.37, 95%CI [1.06, 5.29]). More women in the group who had 0-1 abortion (n = 109/420) believed they could not become pregnant at the time of conception, compared to women who had ≥2 abortions (n = 27/161), p=.038. Mood swings, as a contraceptive side-effect, were more often reported among women with ≥2 abortions (n = 65/161), compared to those with 0-1 abortion (n = 131/420), p=.034. Conclusion: Multiple abortions is associated with vulnerability. Sweden provides high quality and accessible comprehensive abortion care; however, counselling must be improved both to achieve contraceptive adherence and identify and address domestic violence. 
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46.
  • Reuterwall, Isa, et al. (författare)
  • Pregnancy planning and neonatal outcome : a retrospective cohort study
  • 2024
  • Ingår i: BMC Pregnancy and Childbirth. - : BioMed Central (BMC). - 1471-2393. ; 24:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundUnplanned pregnancy is common, and although some research indicates adverse outcomes for the neonate, such as death, low birth weight, and preterm birth, results are inconsistent. The purpose of the present study was to investigate associated neonatal outcomes of an unplanned pregnancy in a Swedish setting.MethodsWe conducted a retrospective cohort study in which data from 2953 women were retrieved from the Swedish Pregnancy Planning Study, covering ten Swedish counties from September 2012 through July 2013. Pregnancy intention was measured using the London Measurement of Unplanned Pregnancy. Women with unplanned pregnancies and pregnancies of ambivalent intention were combined and referred to as unplanned. Data on neonatal outcomes: small for gestational age, low birth weight, preterm birth, Apgar score < 7 at 5 min, and severe adverse neonatal outcome defined as death or need for resuscitation at birth, were retrieved from the Swedish Medical Birth Register.ResultsThe prevalence of unplanned pregnancies was 30.4%. Compared with women who had planned pregnancies, those with unplanned pregnancies were more likely to give birth to neonates small for gestational age: 3.6% vs. 1.7% (aOR 2.1, 95% CI 1.2–3.7). There were no significant differences in preterm birth, Apgar score < 7 at 5 min, or severe adverse neonatal outcome.ConclusionsIn a Swedish setting, an unplanned pregnancy might increase the risk for birth of an infant small for gestational age.
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47.
  • Sijpkens, Meertien K., et al. (författare)
  • Results of a Dutch national and subsequent international expert meeting on interconception care
  • 2020
  • Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine. - : TAYLOR & FRANCIS LTD. - 1476-7058 .- 1476-4954. ; 33:13, s. 2232-2240
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The potential value of preconception care and interconception care is increasingly acknowledged, but delivery is generally uncommon. Reaching women for interconception care is potentially easier than for preconception care, however the concept is still unfamiliar. Expert consensus could facilitate guidelines, policies and subsequent implementation. A national and subsequent international expert meeting were organized to discuss the term, definition, content, relevant target groups, and ways to reach target groups for interconception care.Methods: We performed a literature study to develop propositions for discussion in a national expert meeting in the Netherlands in October 2015. The outcomes of this meeting were discussed during an international congress on preconception care in Sweden in February 2016. Both meetings were recorded, transcribed and subsequently reviewed by participants.Results: The experts argued that the term, definition, and content for interconception care should be in line with preconception care. They discussed that the target group for interconception care should be "all women who have been pregnant and could be pregnant in the future and their (possible) partners". In addition, they opted that any healthcare provider having contact with the target group should reach out and make every encounter a potential opportunity to promote interconception care.Discussion: Expert discussions led to a description of the term, definition, content, and relevant target groups for interconception care. Opportunities to reach the target group were identified, but should be further developed and evaluated in policies and guidelines to determine the optimal way to deliver interconception care.
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48.
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49.
  • Skogsdal, Yvonne Rosalie Elisabeth, 1964-, et al. (författare)
  • An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health-a randomized controlled trial
  • 2019
  • Ingår i: Upsala Journal of Medical Sciences. - : Taylor & Francis. - 0300-9734 .- 2000-1967. ; 124:3, s. 203-212
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Reproductive life plan counseling (RLPC) is a tool to encourage women and men to reflect upon their reproduction, to avoid unintended pregnancies and negative health behavior that can threaten reproduction. The aim was to evaluate the effect of RLPC among women attending contraceptive counseling. Outcomes were knowledge about fertility and awareness of preconception health, use of contraception, and women's experience of RLPC.Material and methods: Swedish-speaking women, aged 20-40 years, were randomized to intervention group (IG) or control group (CG). Participants (n = 1,946) answered a questionnaire before and two months after (n = 1,198, 62%) the consultation. All women received standard contraceptive counseling, and the IG also received the RLPC, i.e. questions on reproductive intentions, information about fertility, and preconception health.Results: Women in the IG increased their knowledge about fertility: age and fertility, chances of getting pregnant, fecundity of an ovum, and chances of having a child with help of IVF. They also increased their awareness of factors affecting preconception health, such as to stop using tobacco, to refrain from alcohol, to be of normal weight, and to start with folic acid before a pregnancy. The most commonly used contraceptive method was combined oral contraceptives, followed by long-acting reversible contraception. Three out of four women (76%) in the IG stated that the RLPC should be part of the routine in contraceptive counseling.Conclusions: Knowledge about fertility and awareness of preconception health increased after the intervention. The RLPC can be recommended as a tool in contraceptive counseling.
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50.
  • Skogsdal, Yvonne Rosalie Elisabeth, 1964-, et al. (författare)
  • Contraceptive use and reproductive intentions among women requesting contraceptive counseling
  • 2018
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : John Wiley & Sons. - 0001-6349 .- 1600-0412. ; 97:11, s. 1349-1357
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Limited attention has been paid to the use of contraception in relation to women's family planning intentions. The aim of this study was to investigate the use of contraception during the most recent intercourse as well as the reproductive intentions of Swedish-speaking women requesting contraceptive counseling.Material and methods: Across-sectional baseline survey in a randomized controlled trial regarding reproductive life planning (before randomization). Women requesting contraceptive counseling answered questions about contraception and whether they wanted to have children/more children in the future.Results: In total, 1946 women participated: 33.7% (n = 656) parous and 65.7% (n = 1279) nulliparous. The majority, 87.1% (n = 1682), had used contraception during their latest intercourse; 64.6% (n = 1239) used short-acting reversible contraception, 22.8% (n = 443) used long-acting reversible contraception (LARC), and 12.9% (n = 251) had not used any contraception. A combined oral contraceptive was more common among nulliparous and LARC among parous. Among all women, 64.8% (n = 1253) intended to have children/more children in the future, among parous women 35.7% (n = 220) and among nulliparous 80.0% (n = 1033). Among women who did not intend to have children/more children, 22.6% (n = 60) of parous and 10% (n = 8) of nulliparous had not used contraceptives during their most recent intercourse.Conclusions: Women did not always use contraceptives that were suitable for their reproductive intentions. Questioning women who request contraceptive counseling about their pregnancy intention can give healthcare providers better opportunities for individualized counseling.
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