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 ScotTransPrep: Exploring Scottish transgender and non-binary people's knowledge and attitudes towards sexual health, HIV and preventatitve strategies(2019)Introduction Transgender people and those with a non-binary gender identity suffer multiple societal disadvantages that impair their ability to access adequate healthcare, including in sexual health and HIV prevention, and globally are 49x more likely than the general population to be HIV positive. This study aimed to qualitatively identify knowledge about sexual health, barriers to access experienced by Scottish trans/non-binary (T/NB) people, and their suggestions for improvement. Method The author conducted six semi-structured interviews with T/NB Scottish adults, recruited in person, via social media and sociosexual apps, and thematically analysed data through an intersectional feminist advocational lens, and using a modified Integrative Behaviour Model (Wood et al 2016). Findings Participants were generally well informed regarding identifying their own sexual health needs, and about HIV prevention including PrEP. However, significant barriers, including stigma about trans identities and sexual behaviours, non-inclusively designed services, undertrained staff, financial and time constraints, community behavioural norms, mental health comorbidity, and prioritisation of gender affirming care over sexual health prevented people from accessing care. Concerns about NHS mismanagement and maltreatment have led many to seek private healthcare, paving the way for a two-tier system and worsened inequalities. Suggestions for improvement by participants included dedicated transgender sexual health clinics with staff training, community re-education, and more investment in adequate, timely access to NHS gender care. Conclusions To achieve the above suggestions and improve T/NB health, they argued that sexual health services must be better funded, and substantially and visibly trans-inclusive. Ideally targeted services will be trans-led or with substantive trans community input, and adopt an intersectional approach that bolsters the most vulnerable. T/NB people cannot achieve optimal health and wellbeing without support from healthcare staff and the wider community, including access to gender-affirming care.Item 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.Item “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.Item 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.Item 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.Item 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.Item 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.Item 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.Item 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
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