MSc in Sexual and Reproductive Health

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/7218

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The Impact of Loss in Childbearing on Women in Southern Malawi
(Queen Margaret University, 2015)
This was a secondary research, the original study being conducted in southern part of Malawi and included 23 women of childbearing age who experienced loss. The women were interviewed about their interpretation of loss with a focus on accountability and blame. The study discussed here involves secondary data analysis of the interviews with women who had experienced loss and community focus group discussions with a focus on the psycho-social consequences Objective The objective of this research was to examine the psychosocial consequences which are faced by women who experience loss in childbearing. Methods For the original study; semi-structure and FGDs were used for data collection. Snowballing procedure was adopted to select respondents. Interviews were conducted in both English and Chichewa with 23 women who experienced loss in the last 2 to 5 years. For second research; the transcript were manually analyzed by using thematic analysis to identify themes. Findings The study found that there was a pressing need for support services targeting women who have experiences loss in form of counselling to deal with the psychosocial emotions. Out of 23 women who experience loss only 1 received counselling. The findings revealed that there were psychosocial consequences which included pain, hurt, guilt, blame and detachment. Also the women expressed anxiety for subsequent pregnancy and most women referred to dead babies as "chithuchi" meaning "the thing". Gender and Family dynamics revealed that women were supported by their spouses, family members and friends. The role of care was inadequate and support for women was not provided. Conclusion: In order for women to receive care for psychosocial support there need to be a change in attitude of people in society like Malawi regarding childbearing loss. More research in this field is desirable to increase the knowledge and also to guide formulation of future policies for the government. The Key Words: Pregnancy; Childbearing loss; Gender; Psychosocial Consequences; Family; Dynamics; Malawi; Medical Staff, sub Saharan Africa
An Exploration Of Teachers' Experiences And Perspectives On Implementation Of The Share Programme
(Queen Margaret University, 2015)
Adolescents sexual health in United Kingdom(UK) remains a public health issue. Although teenage pregnancies, unsafe abortions, and sexually transmitted infection rates have declined among adolescents in UK in the last six years, the rates are still highest in Europe. The effectiveness of sexual and relationship education programmes in the country has been debatable over the years. Arguments are centred on whether sexual and relationship education impact on behaviour change or not. Objective: To explore the experiences of teachers who teach sexual and relationship education in the Lothians, Scotland, the SHARE programme. Method: This was a qualitative study. Data was carried out using face to face semi structured interviews in secondary schools. Results: Teachers are instrumental in raising sexual health awareness in adolescents. However they encounter significant barriers in implementing sexual and relationship programmes. More is needed to work in collaboration with sexual health programmes to effect behaviour change.
An Examination of the Factors Influencing Contraceptive Behavior in African American College Students
(Queen Margaret University, 2015)
Introduction: African American women experience higher rates of unintended pregnancies compared to their white counterpart. Recently similar trends were discovered among African American college students. The purpose of this study is to examine the factors that influence contraceptive behavior in African American college students. Methods: Qualitative data was collected from one Focus Group Discussion (FGDs) and six Semi Structured Interviews (SSIs) consisting of African American college students attending The George Washington University or The University of Maryland, College Park. The sample group consisted of 9 females and one male. Data was analyzed via thematic analysis and various analytic matrices. Findings: Participants held knowledge of contraception and had various modes of receiving sexual health information. Condoms and withdrawal were the most popular form of contraception use, followed by birth control and emergency contraception. Concerns about side effects, convenience, and experiences from peers or family members created hesitation to utilize hormonal contraception. Peers and partners were highly influential on one contraceptive behavior, followed my family and media. Conclusion: Socio-cultural factors such as peer, partner, family and media are more influential than other factors (i.e. socioeconomic status, structural factors or knowledge base).
"It's a very complicated issue here": Factors contributing to the limited and declining use of Manual Vacuum Aspiration for postabortion care in Malawi A Qualitative Study of Health Workers Opinions
(Queen Margaret University, 2015)
Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions contribute significantly to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce the adverse consequences of unsafe abortions through emergency care, treatment of incomplete abortion, counseling and contraception. Manual vacuum aspiration (MVA) is recommended for treatment of incomplete abortion by WHO and national policies in Malawi. However, MVA usage in Malawi is low and decreasing, with sharp curettage being used in preference, but little is known about the reasons for this. Using Greenhalgh et al.'s (2004) framework of determinants of diffusion, dissemination and implementation of innovations in healthcare settings, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi, adding to a limited research base about what influences rejection of recommended PAC innovations. The primary data collection method involved semi-structured interviews with health workers who provide PAC in a central hospital and a district hospital in Malawi. Findings and emergent themes were considered in four areas that may be influencing the limited and declining use of MVA: the outer context, the health workers, the organisation and the innovation. Abortion stigma and high rates of unsafe abortions and women presenting for PAC were highlighted as important contextual issues. Health workers described varying attitudes towards PAC. Staff shortages, social interactions, power dynamics and expected job roles create challenges for both PAC provision and MVA use. A lack of a sustainable equipment supplies was considered a major barrier to MVA usage; leadership, training, supervision and feedback and monitoring were also highlighted as important organisational factors. Finally, whilst benefits of MVA were acknowledged, health workers tended to prioritise personal risks and benefits to using MVA. The findings highlighted that these factors interconnect to influence the limited and declining use of MVA. Effective and sustainable PAC will require the consideration of all these factors as well as the wider context and a health systems approach.
A comparison of free maternal health polices in Sierra Leone and Ghana: lessons for Nigeria
(Queen Margaret University, 2016)
INTRODUCTION 1.1. PROBLEM STATEMENT The number of women dying annually from pregnancy, childbirth and attendant complications are still a global concern (WHO 2015). Lack of access to quality healthcare services for pregnancy and delivery are among the reasons for high maternal mortality rates worldwide (Alvarez et al. 2009) with the situation particularly marked in many low-resource settings. For example, despite the reported increase in the proportion of skilled delivery care recorded across the world, only just over half of all deliveries in sub-Saharan Africa are attended by skilled health workers (WHS 2015). Available evidence has shown that the highest number of maternal deaths occur during the delivery and post delivery period (Khan et al. 2006), and increasing access to skilled birth attendance at delivery and provision of emergency obstetric services for women with complications are effective interventions in reducing maternal deaths (Paxton et al. 2005; Rosenfield et al. 2007). In addition, half of the maternal deaths and complications that occur during pregnancy are preventable by antenatal care programs that provide essential services to pregnant women (Abou-Zahr & Wardlaw 2003; Lincetto et al. 2006). Therefore, timely access to maternal care services, therefore, remain an important indicator for monitoring the progress of maternal outcomes including maternal mortality. Access to maternal health services Nigeria is still marked with inequities across geographical and economic gradients (Fagbamigbe & Idemudia 2015a). Financial inaccessibility owing to inability to afford the cost of care have been established as a barrier to use of health facilities, particularly for the poor and vulnerable women (Ekabua et al. 2011). Studies correlating utilisation of maternal health services with models of healthcare financing in low income countries found that higher proportion of government financing is associated with greater utilization of skilled birth attendants and caesarean section (Kruk et al.2007). However, out of pocket financing of the costs of facility delivery has been shown to have substantial repercussion on households including having to borrow money or sell valuable household items making families more vulnerable to impoverishment (Russell 1996; McIntyre et al. 2006). According to Alvarez et al. (2009), Maternal mortality ratios in sub-Saharan African Countries is inversely correlated with per-capita government expenditure on health and directly related to the out-of-pocket expenditure on health, the more out-of-pocket expenditure in health in a country the higher the maternal mortality rate (MMR). Over the last decade, there has been shift towards the eradication of user fees for maternal health services in low and middle income countries with studies showing marked improvement in service coverage with their removal (Ponsar et al. 2011).
Comparing women's access to sexual and reproductive (SRH) services in Uganda and Tanzania: Implications for unsafe abortions
(Queen Margaret University, 2016)
Background: Although the global community promotes people's access to sexual and reproductive health (SRH) services, the worldwide abortion frequency remains increasing. Most women living in the developing world receive unsafe abortions to terminate their pregnancies. This results in numerous maternal mortality and morbidity. Tanzania and Uganda retain restrictive abortion laws and both of them are located in Eastern Africa, where has the highest subregional unsafe abortion rate in the world. However, these two countries present different prognosis when it comes to unsafe abortion. Objective: This study aims to compare the influence of Tanzanian and Ugandan health policies and programs on women's access to relevant SRH services which can be used to deal with unsafe abortions. Methods: According to research questions, this desk study compared relevant academic articles, national and international non-governmental organisations' (NGOs) reports, which are written in English and published during 1994 to June 2016. Findings: Health policies and programmes increase accessibility and affordability of SRH services through facilitating service delivery, such as integrating post-abortion counselling into post-abortion care (PAC) services and decentralising relevant SRH services. Moreover, political environment improves social acceptability through raising people's awareness and promoting gender equity. This approach includes identifying marginalised groups and encouraging male involvement. In addition to these implementation determinants, coordination capability of government plays an influential role in women's access to abortion-related SRH services. Conclusion: From Tanzania and Uganda's experience, countries with restrictive abortion regulations can still deal with unsafe abortion and its consequences through shaping political environments to improve women's access to relevant SRH services. Keywords: SRH services, unsafe abortion, Uganda, Tanzania
Access to Reproductive Health Services for Asylum Seeker and Refugee Women in Scotland.
(Queen Margaret University, 2016)
Refugees and asylum seekers flee their home countries worldwide as a result of conflict and other reasons, and Scotland is home to thousands of refugees and asylum seekers. The aim of this study was to find out possible issues which may arise for refugee and asylum seekers in Scotland when accessing reproductive health (RH) services. The literature search on the rest of the United Kingdom (UK) in relation to access to RH services for asylum seeking and refugee women showed seven key access issues which comprised: communication and the language barrier, missed appointments or late antenatal care (ANC) booking, immigration status, dispersal, insufficient information, provider attitudes and health systems and cultural differences. The UK findings formed the basis for the study questions of the second part of the study which was done through primary data collection. Initial interview questions were more general, followed by questions related to the seven UK findings. Responses from three providers who were interviewed, one from Glasgow (2-6 Sandyford Place) and two in Edinburgh (Pennywell Resource Centre) revealed similarities with the UK findings except in the area of the provider attitude that did not come up during interviews with providers. A web-based search for information materials together with a visit to two facilities in Edinburgh and Glasgow was done in order to analyse how and the type of material on RH services are shared with women and the type of information provided. The findings revealed that although most asylum seeking and refugee women (ASARW) cannot speak or read English, most of the materials were predominantly written in English, which is another challenge to accessing information for these women and the type of information provided. Even though National Health Service (NHS) and Sandyford provide translation and interpretation services, challenges were still experienced in terms of the limited number of key languages that materials can be translated into and the lack of: interpreters for some languages or interprteters of the desired gender, and their limited availability in some cases. Finally, the Liverpool gender analysis framework for health was adapted for discussing the findings in relation to: the environment, bargaining position, resources, activities and gender norms, and Paul Farmer's theory on structural violence was also used. The further broader research was recommended to include ASARW from different countries and groups in order to get a broader perspective on the findings.
Accompanied and Unaccompanied Adolescent Asylum Seekers in Scotland: Access to Sexual and Reproductive Health Services
(Queen Margaret University, 2016)
Adolescent asylum seekers are a vulnerable population who may have faced human rights violations prior to seeking asylum. In addition, there are many challenges when arriving in a new country. These include language barriers, not knowing how to navigate through a health system, lack of health education, and lack of knowledge about current resources. This desk study will use a conceptual framework developed to guide the literature review. This desk study will also look at the literature around what sexual and reproductive health services are available for adolescent asylum seekers in Scotland and what challenges they face when accessing sexual and reproductive health care. This desk study used a systematic approach to the literature review. Databases such as EBSCOHOST, ProQuest, SCOPUS, and Medline were used along with the Journal of Refugee Studies. The results from the literature review shows many challenges that adolescents, asylum seekers, and unaccompanied asylum seekers face. Some challenges include vulnerability to mental health problems, sexual exploitation, lack of health education, and knowledge about local resources. Adolescent asylum seekers also face resource, asylum related, and socio-cultural challenges. This literature review has highlighted many issues that affect adolescent asylum seekers and the need for sexual and reproductive health services. Keywords: Sexual and reproductive health, adolescents, asylum seekers, refugees, Scotland
A COMPARATIVE ANALYSIS OF THE IMPACT OF THE IMPLEMENTATION OF MATERNAL HEALTH POLICIES AND PROGRAMS ON THE UTILISATION OF MATERNAL HEALTH SERVICES AND MATERNAL OUTCOME IN THE SOUTHERN AND NORTHERN REGIONS OF NIGERIA
(2017)
Maternal mortality is a major global public health issue; roughly 300,000 women die annually worldwide from pregnancy-related conditions. Approximately 99% of these deaths occur in developing countries. Nigeria which is one of the developing nations accounts for more than a tenth of maternal mortality rates globally. This poor maternal outcome in the country is said to be associated with poor utilization of maternal health services. Several efforts in forms of policies and programs have been made by the government to improve maternal outcome within the country and attain the MDG5 target. It is not clear the type and level of effect that the implementation of these maternal health policies and programs make on the utilization of maternal health services countrywide. This dissertation sets out to explore the major health policies and programs concerned with utilization of maternal health services, analyze the key factors influencing the implementation of these policies and programs and evaluate how the implementation of these policies and programs impacts the utilization of maternal health services and maternal outcome in various regions of the country. To achieve these objectives, a systematic desk review was carried out and the information gathered was analyzed using WHO health system building block framework. From the data analysis, the key findings revealed that amidst other policies and programs formulated to improve maternal health, the free maternal and child health service policy was a key policy implemented across the country. It was obvious from the analysis that communication gaps in policy formulation processes, resources, contextual factors, governance, among other factors influenced the implementation of these policies and programs countrywide. Despite these efforts, there is still a reasonable gap yet to be closed to meet the MDG5 target. Nonetheless, the maternal health system and utilization of maternal health services have improved in both regions of the country. With greater successes achieved in the south than the north of the country probably due to a higher political commitment by the southern government and deep structural factors distinct to the north. Following these findings, it is recommended that the government should focus on strengthening the maternal health system in the country taking into consideration contextual factors so as to achieve SDG3 targets.
The effects of HIV Stigma on Heterosexual Africans: HIV Prevention and Pre-exposure Prophylaxis in Scotland
(2017)
The aim of this study is to understand how heterosexual Africans in Scotland perceive their HIV risk, HIV prevention, and how the Scottish NHS can support Africans in Scotland with PrEP. To do so this study used qualitative research methods to conduct 3 focus groups in Edinburgh and Glasgow: 2 with HIV-negative Africans and 1 with HIV-positive Africans. The data was analyzed with a concept framework that considers how intersecting HIV stigma, experienced through intersecting social contexts (i.e. heterosexual African), can affect HIV risk and prevention perception. It also explores how anti-stigma strategies can have positive effects on perception of HIV risk and prevention. The results of the study showed that self-stigma, stigma by-association, and public stigma have the most effect on African perceptions of HIV prevention and risk in Scotland. The African community would like to see inclusive PrEP promotion in public places that is culturally appropriate to help reduce stigma and HIV prevention awareness. The participants would also like to see Africans being involved in the process of creating the PrEP promotion material and many in the study believe that PrEP could be beneficial to people in their community to empower their own sexual health choices.
Abortion Practices in Humanitarian Settings - An Analysis of 3 Regions: The Middle East, East Africa, and Europe.
(2017)
Palestinian Women Reproductive Health Rights: Knowledge, Opportunities, Challenges and the Way Forward. A Qualitative Study in Bethlehem Area in the West Bank.
(2017)
Background: Reproductive health rights were declared as fundamental human rights since the ICPD 1994 and the Beijing 1995 conferences. The acknowledgement of the importance of these rights was a momentous point for reproductive health, particularly for women’s health and rights. In the Palestinian context, reproductive health rights are severely affected by the combination of constraints of the political system and the cultural context. Reproductive health rights remain one of the least prioritized matters making them extremely unmentionable. Given the several interrelated issues regarding reproductive health rights of Palestinian women, this dissertation employed the Theory of Intersectionality to guide the various discussions and debates. This theory underpinned the multiple political-demographic and cultural factors/conditions that influence Palestinian women RHR, as well as women’s knowledge, awareness, opportunities and challenges regarding such rights. Methods: A qualitative research was conducted using semi-structured interviews. A purposive sample of ten Palestinian women living in Bethlehem Area in the West Bank was selected. These interviews formed the basis of the analysis. Findings: Findings of this study were considered under five emergent themes: knowledge, information and education; services and resources; Palestinian context and norms; conflict and occupation; violence against women. These intersecting themes shaped women’s knowledge and perceptions of RHR. They highlighted the underpinning factors that influence the existing opportunities and challenges for Palestinian women to access to RHR, as well as health seeking behaviors and overall wellbeing. Conclusion: In insuring universal access to RHR in the Palestinian context, it is recommended that governments should demonstrate commitment to prioritizing RHR initiatives. RHR should be incorporated throughout activities and awareness raising programs. In addition, further researches regarding RHR should be conducted in other areas of Palestine.
Nurses’ perceptions of responding to Intimate Partner Violence in the United Kingdom. An Exploration of the literature.
(2017)
Objectives: Intimate Partner Violence is a global public health concern with devastating consequences for individuals and for wider society. Nurses are uniquely placed to provide support for victim/survivors. The study explores nurses’ perceptions of responding to intimate partner violence in the United Kingdom. Methods: Literature review of the current qualitative research of nurses’ responses to intimate partner violence using the key words ‘Intimate partner violence, domestic violence OR abuse, nurse, nursing, experience, attitudes, belief, education, preparedness’. Search of the electronic databases CINHAL Plus, ProQuest Central, MEDLINE, BMJ Best Practice, BioMed Central, Cochrane Library, PubMed, ScienceDirect also Queen Margaret University library, Royal College of Nursing library, snowballing from references in the text and personal expertise. Findings then synthesised into themes and key concepts. Results: 5 studies were selected to be included in this review. Varying levels of knowledge and understanding were described by the nurses. Most nurses had not had formal education or training on the topic. The majority of studies report that nurses prefer victim/survivors disclose intimate partner violence and feel anxious enquiring about it. Assorted attitudes towards the women were expressed by the nurses including some stereotypical beliefs towards victim/survivors. Environmental factors, fears for personal safety and emotional burden were also cited as barriers to providing effective care. Conclusion: Nurses’ express anxiety and a lack of confidence over managing cases where women experience IPV. Much of this is due to insufficient knowledge. By introducing formal education into the nursing curriculum and compulsory training for qualified nurses this can improve the care women receive.
“Gambians don’t talk to their children about SRH matters. They think their children are virgins…” Contribution of Significant Adults in Providing Sexual and Reproductive Health Information to Adolescents in The Gambia
(2018)
Risky sexual activities amongst adolescents is a major concern in sub-Saharan Africa. Identifying factors that influence risky sexual behaviour is critical to addressing issue like STI, unwanted pregnancies and unsafe abortions. According to UNFPA (2013), 41.5% of young people between 15-24 years in The Gambia were sexually active and around 15% of the sexually active girls had been pregnant at least once and half of those pregnancies were unwanted and occurred mostly amongst school girls. Although studies in other sub-Saharan countries suggests that SRH communication between significant adults and adolescent influence adolescents sexual behaviour, there are scarcely any studies on this subject in The Gambia. This study investigated the contribution of significant adults in providing sexual and reproductive health information to adolescents in The Gambia. A qualitative interpretive approach was chosen for this study. The objective was to use significant adults' explanations of their communication experiences with adolescents to build an understanding of the influential factors that impact such communication. Semi-structured individual face-to-face interviews and focus group discussion were used to gather data from a total of 24 participants comprising of parents and health professionals. Data was audio recorded and then transcribed for analysis. The findings in the present study widely reflects the existing literature on SRH communication between significant adults and adolescents in other countries in sub-Saharan Africa. Significant adults in The Gambia were found to engage adolescents in SRH communication. However, the scope of such communications was very limited and did not adequately address challenges like safe sex and STI protection which adolescents face. It was found that parents and health professionals were both primarily motivated by religious and cultural values, which informed their attitudes about SRH. These values are further reinforced by the limited knowledge of parents as well as gender norms. The findings suggest that significant adults’ contribution to adolescent’s SRH information was poor and inadequate. A number of recommendations were identified and outlined to improve significant adult-adolescent SRH communication.
Influences of social family dynamics in women’s decision making during pregnancy and child birth in rural Morocco.
(2018)
Maternal mortality (MM) is a global health issue with the birth of 130 million babies born in the world every year. Eight hundred women die every single day while giving birth. There are many reasons that lead to their deaths during child-birth and one of these reasons is not attending health care facilities, which could be due to lack of medical facilities, financial barriers and distance. The decision making process to seek such health care is rarely done by mothers on their own. The aim of this research is to explore the decision making process amongst women living in rural areas of Morocco and find what and who influence the mother’s decisions. Findings: Living with in-laws or living separately did not influence the mother’s autonomy to make decisions. Furthermore male involvement was found to be a strong influencing factor in promoting positive health behaviours. Examples of positive health behaviours are: attending antenatal check-ups; eating correct and healthy foods; attending the hospital to deliver the baby; and encouraging mothers to vaccinate their children. The maternal health care facilities had mixed reviews; mothers reported both positive and negative treatment. Conclusion: The decision making process mothers go through during pregnancy, child-birth and during child-rearing is complex with many influencing factors. It is clear from the findings that there is no single change that can be made that will directly encourage women to attend professional health facilities throughout pregnancy and at the time of child-birth. However promoting male involvement, education for both men and women, monitoring and evaluating healthcare facilities and the workforce are several ways that can lead to improvements in mother’s attendance of healthcare facilities and aid in reducing maternal mortality.
“THE STRESS IS ALL ABOUT SEX” Conceptualisations of intimate relationships amongst school attending youth in Sierra Leone
(2018)
Background Sierra Leone (SL) has persistently high levels of adolescent pregnancy and reducing this is a priority. Data that captures the experience of young people (YP) and the decisions that they make about sexual and reproductive health (SRH) is required to help inform education and public health interventions. Objectives This study aims to establish how YP at school in SL understand their rights and responsibilities around sex and relationships, and to find out what the facilitators and barriers to making positive decisions in this area are, with a view to informing locally developed SRH programs. Methods An adapted version of the Participatory Ethnographic Evaluation and Research (PEER) approach was used to involve the YP throughout the research process. Six male and six female students were trained in research methods and met in gender group sessions (GGS) to develop the tools for data collection. Each then interviewed 3 friends and fed these interviews back to the visiting researcher in debriefing sessions. Initial findings were discussed with the participants in GGS for clarification and interpretation. Key informant interviews and notes from the GGS also contributed to the data set. Results Evidence demonstrated the pervasive nature of gender inequalities between the groups. Expectations of the communities and pressure to achieve at school weighed heavily on the young women, and yet the power in relationships remained decisively with the young men. While romantic notions of “good” relationships and the acknowledgement of the benefits of equality were commonplace, sex was referred to negatively by both genders. It was described as a tool of control, with transactional sex and “sexual harassment” portrayed as normal. Relationships were kept secret from all but trusted friends, and the stresses that were associated with navigating them were vividly described as physical and mental illness. Anxiety surrounded pregnancy and there was strong pressure to abort in secret despite the danger this entails. There was no mention of contraception. Conclusion The study demonstrates the need to consider the broad social context when considering SRH interventions. Messages about risks create anxiety amongst females in school, but structural factors significantly limit their ability to influence outcomes. This study suggests the need to work with boys, men and the wider community to share the burden of responsibility, improve knowledge and develop strategies for change.
Factors Influence Omani Women’s Utilization of Postnatal Care Services
(2018)
Oman is one of the countries that achieved a dramatic reduction in maternal and new-born deaths since 1970. One of the strategies that Oman has adopted to reach this achievement is providing free of cost postnatal care services for all Omani women. This includes two visits to primary health care institutions in the weeks two and six postpartum. However, my field observation during my work in different perinatal care clinics in the last two years revealed that many mothers tend to not attend these visits. This study is a cross sectional qualitative study which aimed to explore factors influence women’s utilization of postnatal care services in Oman. Two health care institutions in a city called Nizwa which provide primary care services were included in this study. They are Nizwa Polyclinic and Firq Health Centre. Total of twelve participants were interviewed in depth to collect the data. Keywords: Maternal deaths, new-born deaths, postnatal care, postpartum, utilization of postnatal care services.
A comparative analysis of the contextual factors that were associated with Bangladesh and Zimbabwe achieving relatively high rates of contraceptive prevalence.
(2018)
Background: Family planning is termed one of the best investments a country can make to improve women’s lives by decreasing unwanted pregnancies and unsafe abortions. Hence, many countries have invested in the promotion of family planning by strengthening their family planning programmes. However, despite this, there are currently 214 million women in low and middle-income countries who would like to prevent pregnancy but are not using any modern method of contraception. However, Bangladesh and Zimbabwe are two countries that have shown trends of an increased contraceptive uptake over the years despite their slowed economic growth. Aim: To summarize the contextual factors that are associated with an increased contraceptive uptake in Bangladesh and Zimbabwe. Study Design: A review of literature (Desk Review). Databases: CINAHL, SCOPUS and Medline. Review Methods: The selected studies were published from 1994 to 2018 and were focused on family planning/contraceptive use in Zimbabwe and Bangladesh. The measure evaluation reproductive Health programme conceptual framework was used to organize the study findings and discussion. Results/Findings: 287 articles were retrieved and 19 made the final studies selection. Of the 19 studies,16 were quantitative studies and 3 qualitative studies. It was found that women’s education, older age, place of residence (urban), desire to delay pregnancy/stop childbearing, marital status, male influence – such as discussing FP with husband, being employed, access to FP services, FP workers and FP promotion were the most significant factors influencing contraceptive uptake in both countries. Conclusion& recommendations: To increase contraceptive uptake well thought out information, education and communication (IEC) programmes must be instituted that targets both males and females in rural and urban regions. Further, family planning services must be easily accessible, acceptable, free or extremely low cost and culturally sensitive. Keywords: Contraceptive prevalence, Contextual factors, Unmet need, Bangladesh, Zimbabwe.
EXPLORING THE RISK FACTORS OF GENDER BASED VIOLENCE AGAINST FEMALE SYRIANS IN HUMANITARIAN SETTINGS IN GREECE - A REVIEW OF THE LITERATURE
(2018)
Gender based violence towards female Syrians is a common issue in humanitarian settings in all of the host countries including Greece. This thesis is a review of the literature about the risk factors of violence against female Syrians of all ages in the camps in Greece. It incorporates explanations of the concept of gender based violence and describes the magnitude and severity of the issue. The methodology section includes the strategies in order to develop the topic and the research questions as well as the inclusion and exclusion criteria. For the analysis of the risk factors has been developed an adapted ecological framework of violence that applies to female Syrians who live in humanitarian settings. This analytical framework conceptualizes the Gender Based Violence in the Individual, Microsystem, Exosystem and Macrosystem level. It was found that not only the existing various risk factors from each of the four levels interplay with each other, but new ones emerged due to war and displacement in the Individual and the Exosystem levels. Gender based violence is a sensitive research topic and there are limited researches that took place in Greece amongst displaced Syrians. Researching the risk factors of violence among Syrian women and girls is a challenging and recent topic which requires further and deeper research in the future. People who live in camps deserve decent living conditions, redemption of their reputation in Greek communities and access to tailored health and social services. Key words: GBV, Syrians, Greece, Camps, Risk Factors
Sexuality education: a study exploring the use of participatory exercises in aiding young people’s understanding of the complexities of sexual wellbeing and relationships.
(2019)
Introduction In order to give young people the best chance of embarking on safe, healthy and enjoyable sexual lives, the subject matter, intention, and most importantly delivery method, of sex education must be reconsidered. In this paper, the potential for the use of alternative, arts-based methods of teaching sexuality education in school settings was explored, placing an emphasis on the student voice and agenda. Methodology A review was undertaken of the current body of knowledge surrounding the design of sexuality education programmes and engagement with young people. This included a gender framework and a rights-based comprehensive sexuality education framework. Data was generated for this thesis over a 3-day period with 23 student participants in one school in Dublin, Ireland. Exploratory qualitative research consisted of 2 workshop sessions; one with 10 students and one with 13. These were designed using practical, participatory drama-inspired exercises that supported nuanced understanding of concepts related to sexual health such as consent, boundaries and communication. In addition, young people’s critical evaluation of current sexuality education and the workshop sessions was sought using focus groups. This data was analysed using thematic analysis and presented accordingly. Results Irish young people are ready and eager for extensive sexuality education that addresses issues that influence their lives in an in-depth, practical and relevant way, and that they respond well to alternative participatory methods of indirect instruction. This key finding is explored through seven themes relevant to the research questions; Positivity, Experiential Learning, Consent, Teachers and Teaching Methods, “The Facts”, Gender and Respect. Findings are presented with the student’s voice throughout the process together with researcher observations. Conclusions Young people’s testimony supports the view that Irish school-based sexuality education is failing to engage them in a relevant and productive way. Indirect instruction in the form of drama-based participatory exercises show potential to allow young people to explore complexities related to sexuality in an abstracted, safe environment and help them build a skill set for real-life events.