MSc in Sexual and Reproductive Health
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7218
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Item ‘I couldn’t change the world, but the world changed me.’ Experiences, perspectives and patient care impact of midwives in Scotland following traumatic perinatal and Significant Adverse Events(2024-08-02) Unknown authorIn this dissertation, I explore the experiences of midwives working in Scotland who have been involved in traumatic perinatal or Significant Adverse Events, and how these affected their personal wellbeing and subsequent care provision. By conducting 10 semi-structured interviews with midwives who had worked in a tertiary hospital in the last year, I was able to thematically analyse the data, to which 4 themes arose: feeling unprepared for traumatic events, changes to emotions and personal perceptions, the weight of interpersonal relationships, and systemic frustration from lack of support. The findings suggest the subjectivity of trauma in midwifery and a link between how events are managed and the personal perceptions of those involved. Participants reported feelings of fear, self-criticism, and burnout, which they felt impacted their ability to provide the quality of care they wished to. The importance of supportive interpersonal relationships was emphasised, with many midwives expressing frustration at systemic issues and lack of formal support in policy. This research adds to the growing body of literature on vicarious trauma in maternity care. The findings indicate an intrinsic connection between workplace culture, midwives' self- perceptions, and care quality. Recommendations include implementing automatic support mechanisms, involving staff in defining trauma, and further research into blame culture in healthcare settings. The findings highlight the need for cultural change and improved support systems to enhance both midwife wellbeing and patient safety and satisfaction.Item Stakeholder perspectives on the impacts of inadequate sexuality education on adolescents’ health at schools: A qualitative study in Savar City, Bangladesh(2024-08-18) Unknown authorBackground: Sex education (SE) is regarded as essential to improving adolescents’ sexual and reproductive health and rights. In most impoverished nations, including Bangladesh, teenagers experience problems because they lack knowledge about sexuality, sex, physical changes, puberty, teenage pregnancy, early childbearing, and HIV/AIDS. For this reason, SE is essential. However, the schools in Bangladesh lack government guidance and an appropriate curriculum on SE, even though SE is not in the curriculum as a separate subject. Objectives: This study explored stakeholders’ perceptions regarding inadequate SE at schools and how it impacts adolescents’ health. Also, this study identified barriers that hinder SE provision in schools as well as will provide some suggestions that might be helpful to the school curriculum and other program reviews for ensuring appropriate information access to meet the sexual and reproductive needs of adolescents. Methods and materials: The research chose a phenomenological qualitative study design in a social constructivist paradigm. The study was conducted in Savar Upazila, Dhaka, Bangladesh, between May 2024 and July 2024. A non-probability purposive sampling technique was employed to select stakeholders as study participants Data was collected using two qualitative techniques: an In-depth Interview (IDI) and a Key Informant Interview (KII) followed by the semi-structured interview approach. Interviews were conducted both face-to-face and online. Data saturation was reached after 11 IDIs and 8 KIIs. A thematic analysis approach was utilized to analyze the collected data. Results: The study showed that adolescents had significant knowledge gaps regarding SE. Also, in this study, informants mentioned that SE should be stated at earlier grades as adolescents experience pubertal changes and menstruation earlier than before, and there is a risk of getting wrong information from the internet about sex and reproduction. The study found several perceived health impacts of adolescents due to inadequate SE in schools, such as sexual and reproductive (e.g., STDs, HIV/AIDS, uterine infection, etc.) and mental health (mood swings due to menstruation, stress, depression, and mental trauma), and experiencing teenage pregnancy due to early marriage. Despite numerous health effects, stakeholders mentioned that sexual and reproductive (SRH) content in school curricula is insufficient. Informants stressed that some content was already in the syllabus; however, teachers skipped those due to their shyness and discomfort. The current study discovered that parents were more aware of providing SRH information to girls than boys. Also, the study found that while all stakeholders value sexual education for adolescents, traditional social and cultural factors, religious beliefs, and taboo inhibits open discussion. Informants further mentioned that temporal factors, such as practicing short syllabi due to the COVID-19 emergency, hinder adolescents from knowing about SRH content. Stakeholders expressed the necessity to be supported in teaching SE in schools with an appropriate curriculum, teachers’ training, teaching materials, gender-specific teachers, and parental involvement in the teaching process. Informants also recommended that the imams and other influential people of the community (members and chairman) should be invited to understand the importance of SRH education, and later, they will motivate others. In addition, study results suggested that a separate subject in the curriculum highlighting SRH topics should be incorporated. Conclusion: The perceived health impacts of adolescents due to inadequate SE in schools converge among stakeholders, including adolescents. Moreover, barriers in SE provision in schools leading to SRH’s knowledge insufficiency exacerbate adolescent health impacts. This calls for well-designed interventions. This study also recommends that the government implements measures to assess and monitor SE curricula once integrated into the curriculum and evaluate how schools address it.Item How to further standardize Antenatal care in Sri Lanka to provide sustainable maternal care in the future?(2024)This research aims to assess the complexities and prospects for improving Antenatal care (ANC) services in Sri Lanka, particularly concerning urban-rural inequality, non-communicable disease (NCDs) influence, and the effectiveness of technology and culture in delivering standard ANC services. The study outlines several shortcomings in the provision of ANC services, especially in rural settings characterized by few healthcare facilities, resource constraints, and insufficient numbers of skilled specialists to tackle inequalities in maternal health. The research also points to ways by which these inequalities hinder the improvement of maternal and neonatal health, particularly in rural areas. Pregnant women live with new and rising NCDs including diabetes and hypertension which work to exacerbate the challenges posed to ANC services by illustrating the insufficiency of existing guidelines and provision of resources. This has contributed to disparities in the quality of care received and also the vulnerability of such patients in high-risk pregnancies resulting in the need for clear management plans/ guidelines and improved continuing education of health providers. This research utilizes a desk review method as the research technique, an approach that involves the gathering of data from various sources such as the literature, policies, and information procured from established organizations. The study aims to establish the potential of using technology, with a specific focus on telemedicine and mobile health (mHealth) in overcoming the existing gaps in the provision of ANC services. These technologies are likely to enhance clients’ ability and the quality of care particularly in the rural regions because of potential consultation, follow-ups, and enhanced interaction between the client and the service providers. However, the effectiveness of those technological solutions directly depends on how the problem of the digital divide and the low technical literacy of the rural population will be solved. Another determinant of the adequacy of ANC services is the cultural beliefs of the women. Concerning cultural practices, combined with the involvement of traditional birth attendants (TBA) is seen to enhance the acceptability and utilization of the ANC services. The study is a call for a change in healthcare practices, to better reflect the cultural values of clients and give cultural education to improve maternal healthcare. Therefore, the government must allocate more funds, enhance the guidelines for the management of NCDs, and incorporate technology of cultural relevance into the offer of enhanced ANC services across the country.Item Sexuality and Spirituality in the Bible Belt: A Qualitative Pilot Study Exploring Attitudes Towards Sex and Sexuality(2024-08-04) Unknown authorBackground: The intersection of faith and sexuality remains a complex issue, particularly in regions with strong religious influence. Within this context, understanding how different denominations approach discussions surrounding sex and sexuality is essential to grasp the nuanced interplay between sexual attitudes and religious influences. This study aims to explore these dynamics by examining attitudes towards sexuality among participants from various Christian denominations, shedding light on how diverse religious perspectives shape and influence sexual attitudes. Method: Utilizing a qualitative approach, the research conducted in-depth interviews with church leaders and members from Episcopal, Southern Baptist, and United Methodist congregations in North Carolina. A thematic analysis was conducted through a social constructionist lens to identify and develop themes. Results: A total of 10 themes were identified through the thematic analysis: Biblical Interpretation, Affirming vs. Non-Affirming Stance, Gender Norms, Location Impact, Sexual Shame, Normalizing LGBTQ+ Inclusion, Comfort in Discussing Sexuality, Programs and Resources, Leadership Role, and the Church’s Role in Addressing Sexuality. The discussion defined attitudes in relation to these themes as follows: View of Sex and Sexuality, Affirming vs. Non-Affirming Perspectives, Gender Norms, Comfort with Sexuality, Sexual Shame, and the Role of the Church. The analysis of congregational programs and resources provided insight into how religious leadership can potentially influence individual attitudes toward sex and sexuality. Additionally, geography, community, and biblical interpretations were found to significantly shape both attitudes and the availability of congregational resources. Conclusion: The study underscores the influence that congregations have on individual's attitudes towards sex and sexuality. This presents an opportunity for potential benefits of interfaith dialogue and collaboration with health professionals to develop more comprehensive, affirming resources for congregants.Item Nurses moral compass: The moral dilemma of nurses moral values and professional identity within abortion care.(2024-08-19) Unknown authorIntroduction The procedure of abortion is now nurse-led in the United Kingdom. While nurses are perceived as the supporting role, the moral conflict and emotions associated with abortion has not been considered widely and remains unknown. The stance on abortion will always remain divided among individuals, with many contradicting factors influencing ones ethical standpoint and view on the right to an abortion. Nurses are crucial in the delivery of abortion care. The experiences and factors influencing nurses throughout their involvement in abortion care is currently under researched, specifically reflecting on their moral compass of what nurses’ believe is right and wrong within the context of abortion. Method A narrative review was carried out to explore the moral values and beliefs of nurses, exploring the impact these experiences have on the impact to care given. Levels of support were also identified. The conceptual framework of ‘alternative approach to conscience and participation in abortion care’ is used to examine the factors of moral work in relation to participation in abortion care. Findings Nurses displayed differing moral and values beliefs towards abortion, however, the significance of nurses debating their moral conscience, suppressing and concealing their emotions towards abortion was highlighted in most literature identified. Nurses sought to prioritise their patients support, observing women’s emotions and needs as a priority, ensuring that access to the service was non-judgemental and compassionate. Nurses conveyed a ‘subconscious pressure’ to conform to their professional role, often neglecting themselves and their well-being to provide an effective abortion service. An evident professional expectation was seen throughout, whereby many nurses performed tasks that went against their moral values and beliefs due to the stereotypical role of a nurse. Conclusion Despite working closely in abortion care, nurses face the moral dilemma of their personal beliefs and professional stance. Findings identified the requirement to provide adequate support to nurses throughout abortion care. Often supressing emotions, the ethos of team support was seen a pivotal in abortion provision. Further research is required to improve the experience of abortion for women and healthcare professionals.Item “Learning about it!” What are Primary Education Students’ Experiences of Learning about the Relationships, Sexual Health and Parenthood Curriculum in Initial Teacher Education in Scotland? A Qualitative Pilot Study(2024-08-02) Unknown authorBackground Comprehensive sexuality education, understood as Relationships, Sexual Health, and Parenthood (RSHP) education in Scotland, has long been understood as an effective method for improving sexual and reproductive health. Despite this, it is globally recognised that many teachers responsible for the delivery of comprehensive sex education are not appropriately prepared to teach the subject. Scotland struggles to address the current sexual and reproductive health burden. To date, there is no research in Scotland highlighting how pre-service teachers (those enrolled in a university teacher education program and working toward teacher certification) are prepared to deliver RSHP education upon graduation. Purpose This research aims to pilot the methods for understanding fourth year BA Primary Education students’ experiences of learning about RSHP. It also aims to understand whether pre-service teachers feel appropriately prepared to deliver RSHP education upon graduation as a result of their education. Methods Five semi-structured qualitative interviews were conducted with fourth year BA Primary Education students at Queen Margaret University, Edinburgh. One interview was also conducted with a key informant who was a lecturer in the field of Primary Education. All interviews were carried out online through Teams technology. Interviews were analysed using thematic analysis. Results Participants in the current study recalled very few experiences of learning about RSHP education in university. They were often prohibited from engaging practically with the RSHP curriculum during teacher placements, especially regarding sexual health topics. This resulted in feelings of apprehension about delivering RSHP education upon graduation. Conclusions and implications Semi-structured interviews should be ruled out in future research due to participants limited experiences of learning about RSHP. Future research should utilise quantitative methods to produce more generalisable results that have the potential to inform policy. While results cannot be generalised, this study would suggest that pre-service teachers in Scotland are not being appropriately prepared to deliver RSHP education. Primary school students in Scotland are therefore likely to be missing out on the knowledge necessary to prepare them to protect themselves and their peers SRH.Item The Contribution of Unsafe Abortion to Mortality and Morbidity in Nigeria: A Narrative Review(2024-02-11) Unknown authorIntroduction: Unsafe abortion is a cause of maternal mortality and a leading cause of morbidity among women of reproductive age between the ages of 15 to 49 years. Between 2015 and 2019, an estimated 73.3 million abortions are anticipated to be performed annually, with roughly 8 million of those cases taking place in sub-Saharan Africa (SSA). Unsafe abortion practices play a significant role in Nigeria's high maternal mortality rate of 800 deaths per 100,000 live births. In Nigeria, abortion is only legalised in situations where a mother's life is in danger, such as incest or rape. Objective: This research aimed to identify the complications and maternal mortality associated with unsafe abortion and make recommendations for policy change. Methods: Several databases were used, and the Prisma guidelines for narrative reviews were followed, to conduct a narrative literature review. Among the databases were CNAHL and Med-line. Twenty studies in total were chosen for this study based on the inclusion and exclusion criteria. This research used the human rights framework and feminism theory and a lens to understanding the impact of abortion restrictions on women in Nigeria. Findings: Unsafe abortion leads to maternal mortality in Nigeria and about 8 patients in our study had maternal deaths. Complications from unsafe abortion included bleeding, infection, peritonitis, incomplete abortion, and infertility. The most frequent complications, according to the data, were incomplete abortion (30.3%), sepsis (27.17%), and haemorrhage (20.27%). Maternal deaths were 2.3%. Recommendation: There is a need for policy change in Nigeria due to unsafe abortion related complications and mortality. Abortion should also be allowed following mental, social and economic reasons and also on a woman’s request. Conclusion: There is substantial evidence that unsafe abortion leads to maternal mortality and complications, hence there is a need for policy reform on unsafe abortion.Item “IT IS BETTER TO PREVENT IT WITH THIS VACCINE”: HUMAN PAPILLOMAVIRUS VACCINATION IN NIGERIA- AWARENESS, WILLINGNESS TO ACCEPT, AND LESSONS FROM THE WORLD HEALTH ORGANIZATION (WHO) AFRICAN REGION: A NARRATIVE REVIEW(2023-08-22) Unknown authorBACKGROUND: Human Papillomavirus vaccination (HPV) is an effective means of controlling cervical cancer, one of the leading causes of cancer-related deaths in Nigeria. The past decade has seen the implementation of national HPV vaccination programmes across sub-Saharan African countries. This review aims to explore the deterring and driving factors of awareness and acceptance of HPV vaccination in Nigeria, and the lessons and challenges from implementation of HPV vaccination programmes in the WHO African region. METHODS: This narrative review employed and adapted two search strategies to each selected electronic database: African Index Medicus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Medline, Livivo, PubMed, ProQuest, and Scopus. They were geared towards capturing the various expressions of driving and deterring factors of HPV vaccination awareness, acceptance, and lessons of pilot and national HPV implementation programmes in the WHO African Region. Zotero and Rayyan Software applications were used for the management of data. RESULTS: 40 articles were included in this review. Awareness of HPV vaccination was generally poor but willingness to accept HPV vaccination was high. Deterring factors were lack of information, fear of adverse effects, concerns about promiscuity, cultural and religious beliefs, and cost of the vaccine. Driving factors included: health education, and recommendation by health professionals, family, and friends. Massive awareness campaigns, integrated service delivery, community advocacy were success stories. Challenges included insufficient and inadequately trained healthcare workers, improper planning, and media/religious propaganda. CONCLUSION: It is necessary to address the barriers to HPV vaccine awareness and adopt the lessons from the WHO African Region.Item What makes the cut? Understanding the factors that contribute to high cesarean section rates in Brazil – a narrative review.(2023-02-10) Unknown authorBackground: Cesarean sections as a mode of childbirth and access to the procedure can be lifesaving for both mothers and babies. The WHO has proposed a cesarean section rate of 10-15% as being ideal at population level. In Brazil, the rate of surgical births has steady risen since the 1970’s and currently sits around 57%, with stark differences between the public and private sector. However, the different health care sectors do not seem to be the only variable contributing to the high rate of cesarean sections. Methods: A narrative review was conducted. Databases used were “Cochrane”, “LILACS”, “PubMed”, “Scielo”, and “Web of Science”, the search was conducted in May and June 2022. The findings were analyzed according to the framework adapted from the Socio-ecological framework and the Health Belief Model. Results: 26 articles were analyzed. Several factors that determine the rate of cesarean sections have been identified. They include maternal age, education, household income & employment status, planning of pregnancy, skin color & ethnicity, relationship status, birth stories from peers, hospital characteristics and contexts, defensive medicine, health insurance schemes, time of birth, geographical location and access to care, physician-patient relationship, medical conditions, and government recommendations. Women and physicians have different motivations to undergo or perform the procedure. Conclusions: A variety of factors influence the rate of cesarean sections being performed in Brazil. The field of maternal and child health care needs to be restructured in order to decrease the numbers.Item A Systemic Review of Maternal and Mental Health Inequalities in Black and Ethnic Minority Women in the UK(2023-04-28) Unknown authorBackground: Women from Black ethnic backgrounds in the UK, have a higher risk than White women of maternal mortality and morbidity and they express significant concerns about systemic racism, stigma and overall dissatisfaction with care. The total rate of maternal mortality for Black and ethnic minority women has remained constant for more than ten years in comparison to white women. In the UK, death rates for women from various ethnic, age, and socioeconomic categories are known to vary. However, limited studies on how these rates have changed over time for various population subgroups have been conducted. Furthermore, women from ethnic minority groups are also more likely to develop mental health issues than white women. Poor perinatal mental health has a negative impact on maternal morbidity and mortality. Therefore, ensuring that heathcare services are created to match the specific needs of Black and ethnic minority women is paramount. Methods: The systematic search for relevant literature was conducted through two databases: Google Scholar and EBSCO search. Inclusion and exclusion criteria were used to find the contemporaneous, studies. Results: The findings presented with several discussions: the absence of cultural knowledge, ongoing stigma, unacceptable and fragmented health services, interactions with culturally ignorant and dismissive healthcare professionals, and inadequate and misconceptions about mental health all had an impact on Black and ethnic minority women's ability to receive adequate maternal and mental health care in the UK. Conclusion: This study provides insight into the unique challenges faced by ethnic minority women during pregnancy, which intersect with the unique problems posed by dissonance with other healthcare systems, potentially widening existing ethnic disparities in maternal outcomes, maternity care experiences and the significant differences in maternal mortality.