MSc in Sexual and Reproductive Health

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

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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).
Abortion Practices in Humanitarian Settings - An Analysis of 3 Regions: The Middle East, East Africa, and Europe.
(2017)
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
ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH: A REVIEW OF IMPLEMENTATION PRACTICES IN EMERGENCY SETTINGS
(2020)
Merged with the status of children and often adults, adolescents (10-19 years) have been easily overlooked in programs, with much reference on them directed to the ‘young people’ (15-24 years) which had meant negligence to their specific needs (Chandra-Mouli et al, 2019). From the paucity of programs that address essential Adolescent Sexual and Reproductive Health (ASRH) needs, to the meager available research and data of the few implemented ones, ASRH services in emergencies has been ineffective over the years (Kerner et al, 2012). Yet in this inherently disruptive environment with alteration in normalcy and lack of suitable support adolescents are constantly exposed to risky behaviors, sexual assaults, sexually transmitted infections and unsafe abortion (Pearce, et al, 2016).This review goes beyond previous work, by focusing exclusively on adolescents (10-19 years) in emergencies and by providing additional synthesis and analysis of the ASRH implementation features (including the focus of the program) and the challenges in the implementation process, which are not addressed in the existing review . This Literature review utilized Queen Margaret University Online Library which was also linked to MEDLINE data base. This was utilized since it is well linked to PUBMED. Literatures were few, in total 10 studies were reviewed. The data extraction matrix was used for data analysis comparing and contrasting the same category or theme for each of the selected papers. This review found that most of the ASRH interventions in this setting are directed at adolescent behavioral changes, ASRH interventions were deployed piece meal, as they were not combined or delivered together as directed by global guideline (IAWG, 2010), thus adolescents might have limited benefit of an ideal intervention. We also found that community engagement can be achieved from outset through the incorporation of other essentials educational contents apart from ASRH information and services in the implementation packages. It also realized an approach to minimizing program intervention gaps often caused by inadequate funding in this setting. Major limitations of the study were the small number of studies meeting inclusion criteria and the content gaps on ASRH service implementation in humanitarian settings. With narrative approach employed, necessary assessment of quality of the articles was not judiciously carried out as it would have been expected in a systematic review. We believe that this is justified by the aim of being as comprehensive as possible
“All countries should work toward decriminalization of sex work”: A Feminist Analysis on New Zealand’s Decriminalisation and Sweden’s Criminalisation and the Unfinished Sexual Rights Agenda
(2022)
In 2012, The World Health Organisation (WHO) recommended that “All countries should work towards decriminalisation of sex work”. Currently, New Zealand (NZ) is the only nation that has decriminalised sex work (SW). The Guttmacher institute notes that there is an “Unfinished Sexual Rights Agenda”, despite impressive global progression. The major study question asks to what extent does criminalisation and decriminalisation constrain and enable sex workers in achieving full sexual and reproductive health rights? This comparative analysis is made through examining polarising frameworks of the New Zealand Model (NZM), and the Swedish Model. The research question is addressed by conducting a thematic analysis on studies and policy reviews within NZ and Sweden, from an online database search. Feminist theory is used to guide the analysis of findings along with an amended harm reduction framework that guides the discussion. It was found that although NZ have made progression toward the WHO’s recommendation and have contributed to closing a gap in the unfinished sexual rights agenda, the issue of chronic stigma surrounding SW remains. Recommendations for the WHO, and both countries of NZ and Sweden have been made, along with recommendations for the UK to help guide their decision in which framework to adopt. To decrease stigma, NZ should upscale the approach in decriminalisation and provide better support provision for sex workers. Sweden is recommended to measure harm for sex workers within the current environment. The UK is encouraged to conduct primary research into both polarising frameworks, but ultimately move toward the NZM.
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).
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.
Analysing intersecting inequalities in ‘women’s health’ that affect people’s experiences of endometriosis pain: A narrative review
(2021)
Introduction Endometriosis is a chronic menstrual condition that often leads to severe pain and reduced quality of life (QOL). Intersecting inequalities impact on people’s experiences of pain, access to health care, QOL and health outcomes. Existing research into ‘women’s health’ and specifically endometriosis, focuses on the most privileged social identities, limiting its representation and understanding of all people living with endometriosis. Methods Thematic analysis and theory were used to analyse secondary data to understand how intersecting social factors, at the micro, meso and macro levels, impact on people’s experiences of endometriosis pain (EP). Findings Seven higher order themes emerged in the findings which emphasise how social factors impact on people’s experiences of EP. At the intrapersonal level these are: Experiencing EP, Impact on QOL, Social expression of EP. At the interpersonal level these are: Health care professionals’ perceptions of pain and Social perceptions and gendered roles. At the structural level these are: Awareness and education, Communication and language and Diagnostic delays. Conclusion Social factors can negatively impact on an individual’s experiences of EP, access to healthcare, QOL and health outcomes. Future research, policy and practice development must be representative of all People Living with Endometriosis (PLWE) to reduce inequalities in health.
AN ANALYSIS OF THE RESULTANT EFFECTS OF POST TRAUMATIC STRESS DISORDER(PTSD) ON PEOPLE LIVING IN ACTIVE-CONFLICT ZONES IN NORTHERN NIGERIA
(2022)
The increasing cases of violence in Northern Nigeria as a result of insurgency by the Boko Haram sect as well as the activities of bandits in the region have exposed residents in the area to active conflict. A considerable number of the victims exposed to active conflict in Northern Nigeria have shown symptoms of PTSD. It is for these reasons that this study was conducted to investigate the effect of exposure to active conflict on victims in Northern Nigeria and whether it caused the development and exacerbation of PTSD levels. The absence of social support networks, educational attainment level and level of income were explored as factors that worsened the effects of exposure to active conflict. The experiences of victims living in camps for internally displaced persons and the application of psychosocial interventions, religious activities, and group activities were thoroughly analysed in this research. This study is significant as it reiterates what is already known about the negative relationship between exposure to active conflict and PTSD development. In addition, it provides valuable information on the poor mental healthcare provided for the victims of exposure to active conflict in Northern Nigeria and suggests ways to ameliorate this healthcare gap. 
The association between mid-term iron-deficiency and pregnancy outcomes in a malaria-endemic region of Papua New Guinea and implications for policies and clinical practice
(2020)
Barriers to accessing healthcare services by the LGBTIQ community: A comparative study from Nepal and India
(2020)
Background: It has been more than a decade since Lesbian, Gay, Bisexual, Transgender, Intersex and Queer (LGBTIQ) rights were first implemented in Nepal and India. However, it is still being reported that LGBTIQ people are deprived of fundamental rights and health due to discrimination and stigma. Sexual and gender minorities are subjected to many challenges while accessing health care. This study investigates the enabling and constraining factors that influence health care access and utilization of people who identify as LGBTIQ in Nepal and India. Methods: A comparative desk-based study used Queen Margaret University (QMU) electronic library resources to search and identify peer-reviewed articles published between 1994 and 2020 in key databases including PubMed, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Moreover, Google Scholars advanced was employed for Nepal and India. Online resources like government and various organisational portals were also used to obtain grey literature on the concept of LGBTIQ access and utilization of health care services. The Ryckvier (2018) framework was employed to examine enabling and constraining factors for accessing health care and utilization by LGBTIQ in Nepal and India. A total of 3640 and 18375 articles related to Nepal and India respectively were identified and screened after which 14 articles from Nepal and 17 articles from India were selected for this study. Results: The findings show that access to health care services in both countries is poor due to the negative and discriminating behaviour of health care professionals towards LGBTIQ people. The key barriers were; a lack of LGBTIQ friendly services and admission procedures; physical, financial and distance barriers, and lack of competent staff who understood and identified their reasons for accessing health care services. Additionally, social environment determinants such as the internalised stigma of sexual minorities, rejection by family, society, peers and LGBTIQ communities (Masters), criminalisation, misuse of power by higher authorities and lack of legal support influenced LGBTIQ access to health services and utilisation. Thus, they are more susceptible to health-related problems such as depression, STDs (including HIV), loneliness, and suicidal attempts. Conclusion: To ensure increased access and health service utilisation by LGBTIQ people in Nepal and India, it is essential for individual health care professionals, policymakers and the administrative department (public and health services) to support and understand LGBTIQ health, issues and rights without discrimination. The wider community, as well as the health team, must accept their sexual and gender identity and treat them as human beings with individual’s needs. The government must intervene with specific LGBTIQ oriented laws that protect and address their rights. Key Words: A comparative study, Nepal, India, stigma, discrimination, barriers, health care access, service utilisation health, LGBTIQ
Barriers to Sexual Health Services Faced by the Adolescent Population in Mexico – A Narrative Review
(2021)
Adolescent sexual health is seen to be a growing issue globally with the adolescent population continuing to rise rapidly. In order for countries to meet to Sustainable Development Goals (SDG) sexual health services must be accessible for all, including adolescents. Mexico is seen to be making some progress through new policy introduction however many barriers still inhibit adolescents from accessing sexual health services. This study is a narrative review of the literature to uncover the barriers to sexual health services facing the adolescent population in Mexico as well as understanding how this may impact sexual health outcomes. An electronic search was conducted through Web of Science, PubMed, Medline, CINAHL, Science Direct, Scopus and Discover for peer reviewed articles published in the English language between 2010 and 2020 on adolescent sexual health in Mexico. A total of 81 papers were retrieved from the search from which 13 meeting the inclusion criteria and selected for the final review. From the literature four main themes emerged as barriers preventing adolescents in Mexico accessing Sexual Health services. These themes are; 1) Education, 2) Parental Support and Communication, 3) Accessibility and Availability of Services, 4) Cultural Barriers to Sexual Health Services. This study concludes that adolescents still continue to face barriers to sexual health services and in order for these barriers to be overcome multiple steps must be taken. Sex education must be improved to provide adolescents with the correct knowledge of sexual health and the services that are available to them. Further information must be provided to the wider community to reduce the stigma associated with sexual health and accessing sexual health services. Finally, Adolescent Friendly Health Services (AFHS) must be made available to the adolescent population to ensure they are receiving safe, confidential and evidenced based case through a service that meets their needs.
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.
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.
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
Comprehensive’ Sex Education in Secondary Schools' Impact on Young Adults Aged 18-25. The Perceptions of Positive, Intimate Relationships and How Relationships with Self and Others Are Built From This.
(2021)
Sex education is a significantly important and impactful subject taught in across the world. Sexual health and well-being relate to a wide range of issues including sexuality, unintended pregnancy and abortions, and STI prevention. Relationships start being built intimately from early teenage years and sex education can influence how people view themselves as individuals and how they build relationships with others. This study aims to understand the effects that sex education in secondary schools has on young adults’ perceptions of CSE, and how this impacts the relationships they have with themselves and build with others around them, particularly in an intimate fashion. This research focuses on young adults as opposed to adolescents as it is currently extremely little on how sex education served those aged 18-25, which is incredibly important to evaluate in seeing how successful the curriculum is working in educating young people. The data for this research has been collected through online fully anonymized questionnaires. The results of the research show the impact CSE has had on the young people involved in this project is more negative than positive or has had little to no impact on them and their relationships with themselves or others. There are recommendations given by participants in what they want to see added to the CSE curriculum, some of which have been added in the 2019 guidelines implemented in 2020 including LGBTQIA+ and consent, among others which are yet to be addressed such as female pleasure.
The Contribution of Unsafe Abortion to Mortality and Morbidity in Nigeria: A Narrative Review
(2024-02-11) Unknown author
Introduction: 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.
THE DEMAND AND SUPPLY BARRIERS TO ADOLESCENTS’ ACCESS AND UTILIZATION OF FAMILY PLANNING (FP) SERVICES IN THE NORTHERN REGION OF MALAWI
(2020)
Background: The government of Malawi has been committed to providing a comprehensive and integrated Sexual and Reproductive Health (SRH) package at all levels since 1997. However, adolescents continue to face many health problems like gender inequality, unplanned pregnancies, unsafe abortion, and sexually transmitted infections (STI’s). Most interventions have been unable to effectively address adolescents’ unmet needs and access and utilization of FP services among adolescents remain low. This study investigates the supply and demand barriers to adolescent access and utilization of family planning (FP) services in northern Malawi, one of the areas most affected by preventable SRH problems. Identifying these barriers may assist in planning efforts to increase unmet needs. Methods: This desk-based study used Queen Margaret University (QMU) electronic library resources to search and identify peer-reviewed articles published between 1994 and 2019 in key databases like PubMed, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Online resources like government and various organizational portals were also utilized to obtain grey literature on the concept of adolescent’s access and utilization of FP services. A total of 368 articles were identified and screened after which 30 articles were selected for this study. Findings: The study findings show high coverage and awareness of FP services in northern Malawi. However, awareness is partial in that it mainly relates to contraceptives instead of general sexual reproductive health (SRH) services. Several issues relating to supply and demand-side health determinants like religious and cultural constraints, childbearing preferences, gender and power relations, misconceptions and fear of modern contraceptives significantly influence adolescents’ access and utilization of FP services. Conclusion: To ensure continued and increased access and utilization of FP services by adolescents, it is crucial for policymakers, program planners and implementers to mobilize community support by developing culturally contextualized sexual health interventions. Community acceptance is crucial to both seeking and engaging with health services. The acceptability of FP services not only depend on health providers ability to understand the religious, cultural, historical and social fabric of the people they serve but may also require a thoughtful level of interaction that ensures that those who perceive the need for FP services will continue to use them.
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.