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1.
BMC Womens Health ; 20(1): 267, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33261591

RESUMO

BACKGROUND: High number of unintended pregnancies-often leading to induced abortions-are reported among female sex workers (FSWs), highlighting a major unmet need for contraception. To better understand barriers to contraceptive use, we explored FSW's pregnancy perceptions and experiences of unintended pregnancy. We hypothesized that sex work exacerbates barriers to contraceptive use and that FSW's pregnancy perceptions and experiences of unintended pregnancy influence future commitment to contraceptive use. METHODS: We conducted in-depth interviews with 11 FSWs (January-June 2019) in Dar es Salaam, Tanzania. We purposively sampled FSWs with a positive pregnancy test from those participating in a HIV vaccine preparedness cohort. We used open ended questions to explore how FSWs make decisions when facing barriers to contraceptive use, dealing with unintended pregnancy and adhering to contraceptive use after experiencing unintended pregnancy. All interviews were conducted in Kiswahili, audio-recorded, transcribed and translated into English. Grounded theory approach was used to analyse transcripts. Open and selective coding was performed using Nvivo software. RESULTS: FSWs reported that sex work impedes good contraceptive behaviour because sex workers felt unable to negotiate consistent condom use, avoided health services due to stigma, missed monthly contraceptive supplies because of inconvenient clinic operating hours or skipped contraceptive pills when intoxicated after taking alcohol. FSWs who perceived pregnancy to be a burden terminated the pregnancy because of fear of loss of income during pregnancy or child rearing expenses in case child support was not assured by their partners. FSWs who perceived pregnancy to be a blessing decided to keep the pregnancy because they desired motherhood and hoped that children would bring prosperity. Family planning counselling and availability of contraceptives during postpartum care influenced the initiation of contraception among FSWs. Financial hardships related to childrearing or painful abortion experiences influenced FSWs' commitment to good contraceptive practices. CONCLUSION: Our results demonstrate that FSWs face barriers to initiating and adhering to contraceptive use because of sex work stigma, inability to negotiate condoms and failure to access medical services at their convenience. Our findings underscore the need to integrate contraceptive services with HIV programs serving FSWs in their areas of work.

2.
Sex Reprod Healthc ; 23: 100486, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31951913

RESUMO

OBJECTIVES: To investigate contraceptive uptake among PAC-seeking women reporting either planned pregnancies (PP) or unplanned pregnancies (UP) and to identify factors associated with UP. STUDY DESIGN: This was a sub-study nested in randomised controlled trial (RCT) on women who sought PAC in a low-resource setting in western Kenya. The analysis was based on 807 women who were followed up at 7-10 days and by 472 women at 3 months. MAIN OUTCOME MEASURES: Descriptive statistics and a binary logistic regression model with odds ratios (OR) and 95% confidence intervals (CI) were used. RESULTS: Of the 807 women, 375 (46.3%) reported UP, and 432 (53.3%) PP. Most women, regardless of reported pregnancy intention, agreed to start using contraceptive methods: UP 273 (72.8%) and PP 338 (78.2%), respectively, P = 0.072. Independent factors associated with UP were young age (14-20 years; OR 1.177; 95% CI, 1.045-2.818; P = 0.033), unmarried status (OR 9.149; 95% CI, 5.719-14.638; P < 0.001), nulliparity (OR 1.968; 95% CI, 1.287-3.008; P = 0.002), concealed pregnancy (OR 7.708; 95% CI, 3.299-18.012; P < 0.001) and absence of a partner at the clinic visit (OR 3.174; 95% CI, 2.214-4.552; P < 0.001). At 3-month follow-up, there was no difference in contraceptive use between the UP group (161; 77.4%) and the PP group (193; 73.7%), P = 0.350. CONCLUSION: Contraceptive counselling should be systematically offered to all PAC-seeking women, regardless of their stated pregnancy intention. Adolescents, unmarried women, nulliparous, women with concealed pregnancy and attending the PAC clinic without a partner should be given extra attention by PAC providers offering contraceptive counselling.

3.
Sex Reprod Health Matters ; 27(3): 1652028, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31533554

RESUMO

Social stigma related to women's reproductive decision-making negatively impacts the health of women. However, little is known about stigmatising attitudes and beliefs surrounding abortion and contraceptive use among adolescents. The aim of this study was to measure stigmatising attitudes and beliefs regarding abortion and contraceptive use among secondary school students in western Kenya. A self-reported classroom questionnaire-survey was administered in February 2017 to students at two suburban secondary schools in western Kenya. Two scales were used to measure the stigma surrounding abortion and contraceptive use - the Adolescent Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale and the Contraceptive Use Stigma (CUS) scale. 1,369 students were eligible for the study; 1,207 (females = 618, males = 582) aged 13-21 years were included in the analysis. Descriptive statistics, Pearson's χ2 test, and the t-test were used to analyse the data. Binary logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). The students reported stigma associated with abortion (53.2%), and contraceptive use (54.4%). A larger proportion of male students reported abortion stigma (57.7%) and contraceptive use stigma (58.5%), compared to female students (49.0%, p = .003 and 50.6%, p = .007, respectively). Higher scores were displayed by younger rather than older age groups. No associations were identified between sexual debut and abortion stigma (p = .899) or contraceptive use stigma (p = .823). Abortion and contraceptive use are stigmatised by students in Kenya. The results can be used to combat abortion stigma and to increase contraceptive use among adolescents in Kenya.


Assuntos
Aborto Induzido , Comportamento Contraceptivo , Conhecimentos, Atitudes e Prática em Saúde , Estigma Social , Estudantes/psicologia , Aborto Induzido/estatística & dados numéricos , Adolescente , Comportamento Contraceptivo/estatística & dados numéricos , Estudos Transversais , Tomada de Decisões , Feminino , Humanos , Quênia , Masculino , Instituições Acadêmicas , Autorrelato , Adulto Jovem
4.
Reprod Health ; 15(1): 166, 2018 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-30285768

RESUMO

BACKGROUND: Unwanted pregnancies and unsafe abortions are prevalent in regions where women and adolescent girls have unmet contraceptive needs. Globally, about 25 million unsafe abortions take place every year. In countries with restrictive abortion laws, safe abortion care is not always accessible. In Kenya, the high unwanted pregnancy rate resulting in unsafe abortions is a serious public health issue. Gaps exist in knowledge regarding women's decision-making processes in relation to induced abortions in Kenya. Decision-making is a fundamental factor for consideration when planning and implementing contraceptive services. This study explored decision-making processes preceding induced abortion among women with unwanted pregnancy in Kisumu, Kenya. METHODS: Individual face-to-face in-depth interviews were conducted with nine women aged 19-32 years old. Women who had experienced induced abortion were recruited after receiving post-abortion care at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) or Kisumu East District Hospital (KDH) in Kisumu, Kenya. In total, 15 in-depth interviews using open-ended questions were conducted. All interviews were tape-recorded, transcribed and coded manually using inductive content analysis. RESULTS: Respondents described their own experiences regarding decision-making preceding induced abortion. This study shows that the main reasons for induced abortion were socio-economic stress and a lack of support from the male partner. In addition, deviance from family expectations and gender-based norms highly influenced the decision to have an abortion among the interviewed women. The principal decision maker was often the male partner who pressed for the termination of the pregnancy indirectly by declining his financial or social responsibilities or directly by demanding termination. In some cases, the male partner controlled decision-making by arranging an unsafe abortion without the woman's consent. Strategic choices regarding whom to confide in were employed as protection against abortion stigma. This contributed to a culture of silence around abortion and unwanted pregnancy, a factor that made women more vulnerable to complications. CONCLUSIONS: The findings suggest that financial, social and gender-based dependencies influence women's agency and perceived options in decision-making regarding abortion.


Assuntos
Aborto Induzido/psicologia , Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Gravidez não Desejada/psicologia , Adolescente , Adulto , Feminino , Humanos , Quênia , Gravidez , Pesquisa Qualitativa , Estigma Social , Adulto Jovem
5.
PLoS One ; 13(8): e0201214, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30096148

RESUMO

AIM: The aim was to explore contraceptive uptake, associated factors and satisfaction among post abortion-care (PAC) seeking women in Kenya. Due to unsafe abortions, almost 120 000 Kenyan women received PAC in 2012, and of these women, 70% did not use contraception before pregnancy. METHODS: This study was nested in a larger randomised controlled trial, where 859 women sought PAC at two public hospitals in Kisumu, in June 2013-May 2016. The women were randomly assigned to a midwife or a physician for PAC, including contraceptive counselling, and followed up at 7-10 days and three months. Associated factors for contraceptive uptake were analysed with binary logistic regression, and contraceptive method choice, adherence and satisfaction level were examined by descriptive statistics, using IBM SPSS Statistics for Windows, Version 22.0. RESULTS: Out of the 810 PAC-seeking women, 76% (n = 609) accepted the use of contraception. Age groups of 21-25 (OR: 2.35; p < 0.029) and 26-30 (OR: 2.22; p < 0.038), and previous experience of 1-2 gravidities (OR 1.939; p = 0.018) were independent factors associated with the up-take. Methods used: injections 39% (n = 236); pills 27% (n = 166); condoms 25% (n = 151); implant 7% (n = 45) and intrauterine device (IUD) 1% (n = 8). At 3-month follow-up of the women (470/609; 77%), 354 (75%) women still used contraception, and most (n = 332; 94%) were satisfied with the method. Reasons for discontinuation were side-effects (n = 44; 39%), partner refusal (n = 27; 24%), planned pregnancy (n = 27; 24%) and lack of resupplies (n = 15; 13%). CONCLUSIONS: PAC-seeking women seem highly motivated to use contraceptives, yet a quarter decline the use, and at 3-month follow-up a further quarter among the users had discontinued. Implant, IUD and permanent method are rarely used. Strategies to improve contraceptive counselling, particularly to adolescent girls, and to increase access to a wide range of methods, as well as provider training and supervision may help to improve contraceptive acceptance and compliance among PAC-seeking women in Kisumu, Kenya.


Assuntos
Aborto Induzido , Anticoncepção/métodos , Aborto Incompleto , Adolescente , Adulto , Aconselhamento , Feminino , Humanos , Quênia , Modelos Logísticos , Pessoa de Meia-Idade , Tocologia , Cooperação do Paciente , Satisfação do Paciente , Médicos , Gravidez , Atenção Secundária à Saúde/métodos , Adulto Jovem
6.
BMJ Open ; 7(10): e016157, 2017 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-29018067

RESUMO

OBJECTIVE: To assess the effectiveness of midwives administering misoprostol to women with incomplete abortion seeking post-abortion care (PAC), compared with physicians. DESIGN: A multicentre randomised controlled equivalence trial. The study was not masked. SETTINGS: Gynaecological departments in two hospitals in a low-resource setting, Kenya. POPULATION: Women (n=1094) with incomplete abortion in the first trimester, seeking PAC between 1 June 2013 to 31 May 2016. Participants were randomly assigned to receive treatment from midwives or physicians. 409 and 401 women in the midwife and physician groups, respectively, were included in the per-protocol analysis. INTERVENTIONS: 600 µg misoprostol orally, and contraceptive counselling by a physician or midwife. MAIN OUTCOME MEASURES: Complete abortion not needing surgical intervention within 7-10 days. The main outcome was analysed on the per-protocol population with a generalised estimating equation model. The predefined equivalence range was -4% to 4%. Secondary outcomes were analysed descriptively. RESULTS: The proportion of complete abortion was 94.8% (768/810): 390 (95.4%) in the midwife group and 378 (94.3%) in the physician group. The proportion of incomplete abortion was 5.2% (42/810), similarly distributed between midwives and physicians. The model-based risk difference for midwives versus physicians was 1.0% (-4.1 to 2.2). Most women felt safe (97%; 779/799), and 93% (748/801) perceived the treatment as expected/easier than expected. After contraceptive counselling the uptake of a contraceptive method after 7-10 days occurred in 76% (613/810). No serious adverse events were recorded. CONCLUSIONS: Treatment of incomplete abortion with misoprostol provided by midwives is equally effective, safe and accepted by women as when administered by physicians in a low-resource setting. Systematically provided contraceptive counselling in PAC is effective to mitigate unmet need for contraception. TRIAL REGISTRATION NUMBER: NCT01865136; Results.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Induzido , Misoprostol/uso terapêutico , Enfermeiras Obstétricas , Médicos , Serviços de Saúde Reprodutiva/normas , Aborto Incompleto , Adulto , Feminino , Recursos em Saúde , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Tocologia , Avaliação de Resultados em Cuidados de Saúde , Segurança do Paciente , Satisfação do Paciente , Gravidez , Primeiro Trimestre da Gravidez , Recursos Humanos
7.
Cult Health Sex ; 19(11): 1286-1300, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28398161

RESUMO

Unsafe abortion in Africa continues to be a major contributor to the global maternal mortality which affects young women in particular. In Uganda, where abortion is legally restricted and stigmatised, unsafe abortion is a major public health issue. We explored reproductive agency in relation to unsafe abortion among young women seeking post-abortion care. Through in-depth interviews we found that reproductive agency was constrained by gender norms and power imbalances and strongly influenced by stigma. Lack of resources and the need for secrecy resulted in harmful abortion practices and delayed care-seeking. Women did not claim ownership of the abortion decision, but the underlying meaning in the narratives positioned abortion as an agentive action aiming to regain control over one's body and future. Women's experiences shaped contraceptive intentions and discourse, creating a window of opportunity that was often missed. This study provides unique insight into how young women negotiate and enact reproductive agency in Uganda. Health systems need to strengthen their efforts to meet young women's sexual and reproductive health needs and protect their rights. Enabling young women's agency through access to safe abortion and contraception is paramount.


Assuntos
Aborto Criminoso/psicologia , Saúde Reprodutiva/normas , Comportamento Sexual , Normas Sociais , Adolescente , Feminino , Humanos , Entrevistas como Assunto , Mortalidade Materna , Gravidez , Estigma Social , Uganda , Adulto Jovem
9.
PLoS One ; 11(2): e0149172, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26872219

RESUMO

OBJECTIVE: This study aimed to assess women´s acceptability of diagnosis and treatment of incomplete abortion with misoprostol by midwives, compared with physicians. METHODS: This was an analysis of secondary outcomes from a multi-centre randomized controlled equivalence trial at district level in Uganda. Women with first trimester incomplete abortion were randomly allocated to clinical assessment and treatment with misoprostol by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and stratified for health care facility. Acceptability was measured in expectations and satisfaction at a follow up visit 14-28 days following treatment. Analysis of women's overall acceptability was done using a generalized linear mixed-effects model with an equivalence range of -4% to 4%. The study was not masked. The trial is registered at ClinicalTrials.org, NCT 01844024. RESULTS: From April 2013 to June 2014, 1108 women were assessed for eligibility of which 1010 were randomized (506 to midwife and 504 to physician). 953 women were successfully followed up and included in the acceptability analysis. 95% (904) of the participants found the treatment satisfactory and overall acceptability was found to be equivalent between the two study groups. Treatment failure, not feeling calm and safe following treatment, experiencing severe abdominal pain or heavy bleeding following treatment, were significantly associated with non-satisfaction. No serious adverse events were recorded. CONCLUSIONS: Treatment of incomplete abortion with misoprostol by midwives and physician was highly, and equally, acceptable to women. TRIAL REGISTRATION: ClinicalTrials.gov NCT01844024.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Misoprostol/uso terapêutico , Abortivos não Esteroides/efeitos adversos , Aborto Incompleto/epidemiologia , Adulto , Feminino , Humanos , Tocologia , Misoprostol/efeitos adversos , Uganda/epidemiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-29201404

RESUMO

Background: Young people in Uganda have a large unmet need for modern contraception, and the reasons are unclear. This study describes young peoples' experiences of contraceptive care, client-provider interactions and its aftermath on choice, access and satisfaction. Methods: Simulated client method, with 128 encounters with providers in public and private health care facilities was used. Semi-structured narrative debriefing and a structured questionnaire were used to collect data. Content analysis, descriptive and inferential statistics were applied. Results: Both qualitative and quantitative results highlight favorable reception, provider bias, low client satisfaction and reservations about contraceptive methods. Two thirds of the providers choose a contraceptive method for the client. The clients reported satisfaction with contraceptive services in 29 % of the consultations. Privacy was reported to be observed in 42 % and clients felt respectfully treated in 50 % of the consultations. However, most clients would not recommend the visited facility to others. Client-provider interactions revealed contradictory views on methods to use, whether to first have children, and whether to use contraceptives at all. Younger clients seemed to be treated differently than older clients; contraceptives were provided after a prolonged debate. Inaccurate information about contraceptives was provided and costs were high. Providers conveyed potential adverse effects of contraceptives to young people in a way that indicated providers own fears and doubts. Conclusion: Young people are not able to exercise their rights to choose, obtain and use contraceptives when needed. Overall satisfaction with the services was rated low and client- provider interactions were often unfavorable.

11.
Cult Health Sex ; 18(4): 481-94, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26466639

RESUMO

The effects of obstetric fistula surpass the individual woman and affect husbands, relatives, peers and the community at large. Few studies have documented the experiences of men who live with wives suffering from fistula. In this study, our objective was to understand how fistula affects these men's lives. We conducted 16 in-depth interviews with men in central and western Uganda. We used thematic narrative analysis and discuss our findings based on Connell's theory of hegemonic masculinity. Findings show that the men's experiences conflicted with Ugandan norms of hegemonic masculinity. However, men had to find other ways of explaining their identity, such as portraying themselves as small men but still be responsible, caring husbands and fathers. The few individuals who married a second wife remained married to the wife with the fistula. These men viewed marriage as a lifetime promise before God and a responsibility that should not end because of a fistula. Poverty, love, care for children and social norms in a patriarchal society compelled the men to persevere in their relationship amidst many challenges.


Assuntos
Fístula/complicações , Masculinidade , Cônjuges/psicologia , Adulto , Feminino , Fístula/psicologia , Identidade de Gênero , Humanos , Masculino , Complicações do Trabalho de Parto , Pobreza , Gravidez , Pesquisa Qualitativa , Normas Sociais , Uganda
12.
BMC Womens Health ; 15: 73, 2015 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-26359255

RESUMO

BACKGROUND: Globally, 2-3 million women are estimated to have a genital fistula, with an annual incidence of 50,000-100,000 women. Affected women remain silent within their communities, and their experiences often go unnoticed. Our objective was to explore the experiences of Ugandan women living with genital fistulas to understand how their lives were affected and how they coped with the condition. METHODS: We conducted 8 focus group discussions (FGDs) with 56 purposively selected women with a genital fistula seeking treatment at Mulago Hospital, Uganda. Data were transcribed and analysed using qualitative content analysis. RESULTS: Women with a fistula were living a physically changed and challenging life, living socially deprived and isolated, living psychologically stigmatised and depressed, and living marital and sexual lives that were no longer joyful. The women's experiences were full of life changes and coping strategies, and they used both problem- and emotion-focused coping strategies to deal with the challenges. They devised ways to reduce the smell of urine to reduce the stigma, rejection and isolation. While trying to cope, the women found themselves alone and isolated. Women either isolated themselves or were isolated by society, including by close relatives and their husbands. Their sex lives were no longer enjoyable, and generally, women felt a loss of their marital and sexual rights. CONCLUSION: Women with a fistula make adjustments in their lives to cope with the physical, social, psychological and sexual challenges. They use both problem- and emotion-focused coping to minimise their sense of isolation, as well as the rejection and stigma associated with fistula. These findings are essential for counselling patients, families and community members affected by a fistula. In similar contexts, health programmes should go beyond fistula closure and target communities and families to reduce the stigma and isolation faced by women with genital fistula.


Assuntos
Solidão , Qualidade de Vida/psicologia , Estigma Social , Cônjuges/psicologia , Fístula Urinária/psicologia , Adulto , Atitude Frente a Saúde , Feminino , Grupos Focais , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Procedimentos Cirúrgicos Reconstrutivos/psicologia , Percepção Social , Uganda , Fístula Urinária/cirurgia , Saúde da Mulher
13.
BMC Womens Health ; 15: 63, 2015 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-26286602

RESUMO

BACKGROUND: Female sex workers (FSWs) are a high-risk population for HIV. Correct and consistent use of condoms is the most effective measure for reducing transmission of HIV. Lao PDR is a low HIV-prevalence country, but FSWs have a relatively high HIV prevalence. To be able to make recommendations for condom promotion interventions in Lao PDR it is important to know more about the context specific situation. This study looked at reasons for and associated factors of consistent condom use among FSWs. METHODS: A cross-sectional survey among 258 FSWs in Kaysone Phomvihan district in Savannakhet province was performed. RESULTS: Almost all FSWs had enough condoms (94%), condoms always available (100%) and could always afford condoms (92%). Consistent condom use was 97% with non-regular partners and 60% with regular partners. Almost all respondents (95%) had received information about condoms from the drop-in centre. Stated reasons for consistent condom use were prevention of HIV (94%), STIs (88%) and pregnancy (87%). Most reasons for inconsistent condom use were related to partners not wanting to use condoms because of reduced sexual pleasure. Some FSWs reported that they were physically abused and forced not to use condoms. Shorter time in sex work, higher education and FSW not having regular partners were significantly associated with consistent condom use. CONCLUSIONS: Consistent condom use was very high with non-regular partners, but less frequent with regular partners. The main reason for inconsistent condom use was that the partner did not want to use a condom. Associated factors for consistent condom use were not having regular partners, higher education and shorter time in sex work. Condom promotion programs should include both FSWs and their partners and female condoms should be included in condom intervention efforts. Future studies should investigate the validity of self-reported sexual practices, partners' reasons for inconsistent condom use, risk of violence in sex work and why shorter time in sex work is associated with consistent condom use.


Assuntos
Preservativos/estatística & dados numéricos , Assunção de Riscos , Sexo Seguro/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Sexo sem Proteção/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Promoção da Saúde/métodos , Humanos , Laos , Autoavaliação , Inquéritos e Questionários , Adulto Jovem
14.
PLoS One ; 10(7): e0107624, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26158449

RESUMO

INTRODUCTION: Danish and Norwegian immigrant women in Sweden have an increased risk of cervical cancer compared to Swedish-born women. In addition, Danish and Norwegian immigrant women follow the national recommendations for attendance at cervical screening to much lesser extent than Swedish-born women. The aim of this study was to explore how Danish and Norwegian immigrant women in Sweden reason about attending cervical screening, focusing on women's perceptions as to why they and their compatriots do not attend. METHODS: Eight focus group discussions (FGDs) were conducted with Danish and Norwegian immigrant women living in Stockholm. The women were between 26 and 66 years of age at the time of the FGDs, and were aged between <1 and 48 years old when they immigrated to Sweden. A FGD guide was used, which included questions related to cervical screening, and obstacles and motivators to attend cervical screening. The FGDs were tape recorded and transcribed, and the results analysed according to the principles of qualitative content analysis. RESULTS: The main theme was "Women have a comprehensive rationale for postponing cervical screening, yet do not view themselves as non-attenders". Investigation of women's rationale for non-attendance after being invited to cervical screening revealed some complex reasons related to immigration itself, including competing needs, organisational and structural factors and differences in mentality, but also reasons stemming from other factors. Postponing attendance at cervical screening was the category that linked all these factors as the reasons to why women did not attend to cervical screening according to the recommendations of the authorities. CONCLUSIONS: The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend.


Assuntos
Emigrantes e Imigrantes/psicologia , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Dinamarca , Detecção Precoce de Câncer , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Noruega , Teste de Papanicolaou , Aceitação pelo Paciente de Cuidados de Saúde , Percepção , Rede Social , Apoio Social , Suécia
15.
Reprod Health ; 12: 58, 2015 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-26108479

RESUMO

BACKGROUND: Ugandan law prohibits abortion under all circumstances except where there is a risk for the woman's life. However, it has been estimated that over 250 000 illegal abortions are being performed in the country yearly. Many of these abortions are carried out under unsafe conditions, being one of the most common reasons behind the nearly 5000 maternal deaths per year in Uganda. Little research has been conducted in relation to societal views on abortion within the Ugandan society. This study aims to analyze the discourse on abortion as expressed in the two main daily Ugandan newspapers. METHOD: The conceptual content of 59 articles on abortion between years 2006-2012, from the two main daily English-speaking newspapers in Uganda, was studied using principles from critical discourse analysis. RESULTS: A religious discourse and a human rights discourse, together with medical and legal sub discourses frame the subject of abortion in Uganda, with consequences for who is portrayed as a victim and who is to blame for abortions taking place. It shows the strong presence of the Catholic Church within the medial debate on abortion. The results also demonstrate the absence of medial statements related to abortion made by political stakeholders. CONCLUSIONS: The Catholic Church has a strong position within the Ugandan society and their stance on abortion tends to have great influence on the way other actors and their activities are presented within the media, as well as how stakeholders choose to convey their message, or choose not to publicly debate the issue in question at all. To decrease the number of maternal deaths, we highlight the need for a more inclusive and varied debate that problematizes the current situation, especially from a gender perspective.


Assuntos
Aborto Induzido/legislação & jurisprudência , Aborto Induzido/psicologia , Atitude , Catolicismo , Aborto Criminoso/psicologia , Aborto Legal , Serviços de Planejamento Familiar , Feminino , Direitos Humanos , Humanos , Morte Materna/prevenção & controle , Princípios Morais , Jornais como Assunto , Gravidez , Uganda
16.
BMC Public Health ; 15: 139, 2015 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-25886459

RESUMO

BACKGROUND: Unsafe abortions are a serious public health problem and a major human rights issue. In low-income countries, where restrictive abortion laws are common, safe abortion care is not always available to women in need. Health care providers have an important role in the provision of abortion services. However, the shortage of health care providers in low-income countries is critical and exacerbated by the unwillingness of some health care providers to provide abortion services. The aim of this study was to identify, summarise and synthesise available research addressing health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. METHODS: A systematic literature search of three databases was conducted in November 2014, as well as a manual search of reference lists. The selection criteria included quantitative and qualitative research studies written in English, regardless of the year of publication, exploring health care providers' perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia. The quality of all articles that met the inclusion criteria was assessed. The studies were critically appraised, and thematic analysis was used to synthesise the data. RESULTS: Thirty-six studies, published during 1977 and 2014, including data from 15 different countries, met the inclusion criteria. Nine key themes were identified as influencing the health care providers' attitudes towards induced abortions: 1) human rights, 2) gender, 3) religion, 4) access, 5) unpreparedness, 6) quality of life, 7) ambivalence 8) quality of care and 9) stigma and victimisation. CONCLUSIONS: Health care providers in sub-Saharan Africa and Southeast Asia have moral-, social- and gender-based reservations about induced abortion. These reservations influence attitudes towards induced abortions and subsequently affect the relationship between the health care provider and the pregnant woman who wishes to have an abortion. A values clarification exercise among abortion care providers is needed.


Assuntos
Aborto Induzido , Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , África ao Sul do Saara , Ásia Sudeste , Feminino , Humanos , Gravidez , Pesquisa Qualitativa , Qualidade de Vida
17.
Lancet ; 385(9985): 2392-8, 2015 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-25817472

RESUMO

BACKGROUND: Misoprostol is established for the treatment of incomplete abortion but has not been systematically assessed when provided by midwives at district level in a low-resource setting. We investigated the effectiveness and safety of midwives diagnosing and treating incomplete abortion with misoprostol, compared with physicians. METHODS: We did a multicentre randomised controlled equivalence trial at district level at six facilities in Uganda. Eligibility criteria were women with signs of incomplete abortion. We randomly allocated women with first-trimester incomplete abortion to clinical assessment and treatment with misoprostol either by a physician or a midwife. The randomisation (1:1) was done in blocks of 12 and was stratified for study site. Primary outcome was complete abortion not needing surgical intervention within 14-28 days after initial treatment. The study was not masked. Analysis of the primary outcome was done on the per-protocol population with a generalised linear-mixed effects model. The predefined equivalence range was -4% to 4%. The trial was registered at ClinicalTrials.gov, number NCT01844024. FINDINGS: From April 30, 2013, to July 21, 2014, 1108 women were assessed for eligibility. 1010 women were randomly assigned to each group (506 to midwife group and 504 to physician group). 955 women (472 in the midwife group and 483 in the physician group) were included in the per-protocol analysis. 452 (95·8%) of women in the midwife group had complete abortion and 467 (96·7%) in the physician group. The model-based risk difference for midwife versus physician group was -0·8% (95% CI -2·9 to 1·4), falling within the predefined equivalence range (-4% to 4%). The overall proportion of women with incomplete abortion was 3·8% (36/955), similarly distributed between the two groups (4·2% [20/472] in the midwife group, 3·3% [16/483] in the physician group). No serious adverse events were recorded. INTERPRETATION: Diagnosis and treatment of incomplete abortion with misoprostol by midwives is equally safe and effective as when provided by physicians, in a low-resource setting. Scaling up midwives' involvement in treatment of incomplete abortion with misoprostol at district level would increase access to safe post-abortion care. FUNDING: The Swedish Research Council, Karolinska Institutet, and Dalarna University.


Assuntos
Abortivos não Esteroides/uso terapêutico , Aborto Incompleto/tratamento farmacológico , Tocologia/estatística & dados numéricos , Misoprostol/uso terapêutico , Médicos/estatística & dados numéricos , Aborto Incompleto/diagnóstico , Adolescente , Adulto , Países em Desenvolvimento , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Primeiro Trimestre da Gravidez , Uganda , Curetagem a Vácuo , Adulto Jovem
18.
PLoS One ; 9(11): e112299, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25401756

RESUMO

INTRODUCTION: Two million women worldwide are living with genital fistula with an annual incidence of 50,000-100,000 women. Risk factors for obstetric fistula are context bound. Studies from other countries show variation in the risk factors for obstetric fistula. This study was conducted to identify risk factors for obstetric fistula in western Ugandan context. METHODS: A case control study comparing background factors of women with obstetric fistula (cases) and women without fistula (controls) was conducted in western Uganda. Data was collected using face-to-face interviews. Univariate, bivariate and multivariate analysis was conducted using Stata 12. RESULTS: Altogether, 420 respondents (140 cases and 280 controls) participated in the study. Duration of labour was used to form the product terms when assessing for interaction and confounding since it was one the most significant factors at bivariate level with a narrow confidence interval and was hence considered the main predictor. After adjusting for interaction and confounding, significant risk factors associated with development of obstetric fistula in western Uganda were: Caesarean section (adjusted odds ratio [AOR] = 13.30, 95% CI = 6.74-26.39), respondent height of 150 cm or less (AOR = 2.63, 95% CI = 1.35-5.26), baby weight of 3.5 kg or more (AOR = 1.52, 95% CI = 1.15-1.99), prolonged labour (AOR = 1.06, 95% CI = 1.04-1.08. A quarter of the fistulas had resulted from iatrogenic complication during caesarean section. Compared to no education, post primary level of education was protective against obstetric fistula (AOR = 0.31, 95% CI = 0.13-0.72) and there was no difference between respondents without education and those with primary level education. CONCLUSIONS: Surgeons contribute to a big proportion (25%) of fistula cases hence caesarean section being a risk factor in this region. Other risk factors include; prolonged labour, weight of the baby of 3.5 kg or more, respondent height of 150 cm or less (short stature), and low or no education are risk factors for obstetric fistula in western Ugandan.


Assuntos
Parto Obstétrico/efeitos adversos , Fístula Vaginal/epidemiologia , Fístula Vaginal/etiologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Vigilância em Saúde Pública , Fatores de Risco , Inquéritos e Questionários , Uganda/epidemiologia , Adulto Jovem
19.
Sex Reprod Healthc ; 5(3): 137-41, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25200975

RESUMO

OBJECTIVE: Female sex workers (FSWs) are at risk of unintended pregnancies and induced abortions (IAs). This study aimed to describe attitudes towards and experiences of IA among FSWs in Laos. METHODS: 258 FSWs were interviewed in Kaysone Phomvihan, Laos. Descriptive statistics and logistic regression were used to analyse the data. RESULTS: Overall, 24% of the respondents reported experience of IA. Fifteen percent reported experience of unintended pregnancy after entering sex work, whereof all had ended in IA. Thirty-six percent had self-induced the last IA and 64% were carried out in private clinics. The main reasons for having IAs were paternity denial and lack of financial and social support. A majority agreed or strongly agreed that IA should not be legal in Laos and that women who undergo IA are immoral, but also that IA is the only option a FSW has when experiencing an unintended pregnancy. A positive attitude towards IA was associated with longer duration of sex work and being unmarried. CONCLUSION: IAs were common. Respondents' attitudes and practices reflected limited options when experiencing an unintended pregnancy, and were influenced by negative social perceptions. Interventions targeting FSWs should raise awareness of IA and post-abortion care, and promote dual contraceptive use with highly effective contraceptives.


Assuntos
Aborto Induzido , Atitude , Gravidez não Planejada , Profissionais do Sexo , Aborto Induzido/estatística & dados numéricos , Adolescente , Adulto , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Laos , Modelos Logísticos , Gravidez , Profissionais do Sexo/estatística & dados numéricos , Percepção Social , Mulheres , Adulto Jovem
20.
Front Public Health ; 2: 72, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25072044

RESUMO

The main objective was to assess knowledge, practices, and restrictions faced by young women regarding their menstrual hygiene. The views of adult women having young daughters were also included and both views were compared. In addition, the factors influencing the menstrual hygiene practices were also studied. The study was carried out during 2008 in Mumbai, India. The mixed methods approach was followed for the data collection. Both qualitative and quantitative methods were used to collect the data. For quantitative survey, totally 192 respondents (96 adult and 96 younger women) were selected. While young women were asked about questions related to their menstruation, adult women were asked questions to find out how much they know about menstrual history of their daughters. The qualitative data helped to supplement the findings from the quantitative survey and to study the factors affecting menstrual practices in young women. The mean age at menarche reported was 13.4 years and 30-40% of young girls did not receive any information about menstruation before menarche. It is thus seen that very few young girls between the age group 15 and 24 years did receive any information before the onset of menstruation. Among those who received some information, it was not adequate enough. The source of information was also not authentic. Both young and adult women agreed on this. Due to the inadequate knowledge, there were certain unhygienic practices followed by the young girls resulting in poor menstrual hygiene. It also leads to many unnecessary restrictions on young girls and they faced many health problems and complaints, which were either ignored or managed inappropriately. The role of health sector was almost negligible from giving information to the management of health problems of these young girls. This paper reemphasizes the important, urgent, and neglected need of providing correct knowledge to the community including adolescent girls.

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