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  • 51.
    Kildea, Sue
    et al.
    Australian Catholic University and Mater Medical Research Institute Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Australia.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Govind, Salik
    Office in Mongolia Ministry of Health, Ulaanbaatar, Mongolia.
    A review of midwifery in Mongolia utilising the 'Strengthening Midwifery Toolkit'2012In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 25, no 4, p. 166-173Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The World Health Organization (WHO) developed the 'Strengthening Midwifery Toolkit' in response to an international emphasis on increasing midwifery's role in providing maternal newborn health services. It was used to assist a review of midwifery in Mongolia.

    METHOD: A rapid situational assessment included site visits to eight health facilities and four educational institutions resulting in 30 key informant interviews and six focus group discussions (67 midwives and students). A desk review of pertinent documents (n=19) was undertaken. Data collected included assessments of: midwife competency (n=96), scope of practice (n=2), health facilities (n=8), educational institutions (n=4), legislation and regulation (n=1), and midwifery (n=4) Feldsher-Nurse (n=4) and Bachelor-Nurse (n=1) curricula.

    FINDINGS: Stakeholders in Mongolia are committed to strengthening midwifery across the country to better align with international standards. This requires: a long-term investment in reorientating the health workforce and educational institutions, regulatory changes, educational investment, job description changes which will impact on other maternal newborn health service providers. Additional support and incentives for providers in rural and remote areas is needed and investment in health facilities to enable appropriate infection control; and adequate provision of essential equipment and drugs, are important strategies needed to protect staff. Maternity emergency training is required across the country.

    CONCLUSION: The Midwifery Toolkit was adapted to suit the local context and provided an excellent framework for this review.

  • 52.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Editorial2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 3, p. 85-85Article in journal (Other academic)
  • 53.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Interventions during pregnancy and birth - Call for papers2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 1, p. 1-1Article in journal (Other academic)
  • 54.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Interventions during pregnancy and childbirth - Challenges and opportunities2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 4, p. 159-159Article in journal (Other academic)
  • 55.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Midwife-led care before, during and after childbirth: the best option for most women and babies2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 7, p. 1-1Article in journal (Other academic)
  • 56.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Migration - A global challenge with implications for sexual and reproductive health and care2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 9, p. A1-A1Article in journal (Other academic)
  • 57.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Untitled2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 4, p. 127-127Article in journal (Other academic)
  • 58.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Aneblom, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Limited impact of an intervention regarding emergency contraceptive pills in Sweden: repeated surveys among abortion applicants2006In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 11, no 4, p. 270-276Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate a community-based intervention consisting of an information campaign and advance provision of emergency contraceptive pills (ECP) to abortion applicants. METHODS: Submission of repeated waiting room questionnaires to abortion applicants in two cities in mid-Sweden; one intervention city (IC) and one comparison city (CC) in 2002 (IC = 92, CC = 95) and 2003 (IC = 244, CC = 204). RESULTS: The overall response rate was 90%. The percentage of women who had undergone an abortion within the previous year had decreased in the intervention group but not in the comparison group. Almost two-thirds (63%) of the targeted women had noticed the information campaign and one out of three (33%) who had visited a family planning clinic recalled being given information about ECP. There was a small decline in the use of combined oral contraceptives and intrauterine devices over time. After the intervention, women in the intervention city had better knowledge of ECP and had used it more than women in the comparison city did. CONCLUSIONS: More than half of the targeted women had noticed the information campaign and it may have had a limited impact. Further investigations are needed to determine whether advance supply of ECP to abortion applicants can reduce repeat abortions.

  • 59.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Aneblom, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    The adoption of emergency contraceptive pills in Sweden: a repeated cross-sectional study among abortion applicants2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 9, p. 1142-1143Article in journal (Refereed)
  • 60.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Aneblom, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Odlind, Viveca
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Reasons for pregnancy termination, contraceptive habits and contraceptive failure among Swedish women requesting an early pregnancy termination2002In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 81, no 1, p. 64-71Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: More than 30 000 legal abortions are performed every year in Sweden despite sexual education in schools, widespread youth-clinics and family planning services that are free of charge. The aim of this study was to investigate reasons for induced abortion, contraceptive habits and reasons for contraceptive failure among women presenting for induced abortion.

    METHODS: A questionnaire was administered to 591 Swedish-speaking women consecutively attending three different health care providers concerning an induced abortion during spring 2000.

    RESULTS: The response rate was 88% (n = 518). As many as 43%, among daily smokers 53%, had experienced one or more previous legal abortions. The majority of the women (97%) had discussed the decision about abortion with someone. The most cited reasons contributing to their decision were financial concerns, worries about the relationship and bad timing of the pregnancy. Though 85% had used contraception during the previous year, 36% of the women had not used any contraceptive method at the time of conception. The main reason given for not using contraception was the belief that they could not at that time become pregnant (35%). Ninety percent of the women planned to use contraception after the abortion.

    CONCLUSION: Women's decisions regarding induced abortion are multifactorial. One important reason was "poor economy". One out of three did not use any contraception, as they believed they could not become pregnant. Women presenting for induced abortion are a risk-group for further terminations. Counseling must include information about the fertile window, effective contraceptives and the emergency contraceptive pill.

  • 61.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Berglund, Minna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Jarl, Emelie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Do pregnant women want to know the sex of the expected child at routine ultrasound and are they interested in sex selection?2017In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, no 4, p. 254-259Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the study was to investigate if expecting parents wanted to know the sex of the fetus during ultrasound examination and if they had discussed it with the midwife. Another aim was to explore any interest in sex selection. Methods: A longitudinal survey in early and late pregnancy among 2393 women in Sweden. Results: Almost all (95.8%, n = 2289) women had discussed sex determination with the partner before the ultrasound scan, and 57% (n = 1356) of women and their partners wanted to find out the fetal sex. The expecting parents mostly initiated a discussion with the midwife (46%, n = 1088), but 10% (n = 229) stated that the midwives initiated the discussion. Few (5%, n = 118) expressed a potential interest in selecting sex of a baby. Women who were interested in sex determination did not differ from those who were not, with respect to age, origin, education, parity, level of pregnancy planning, or importance of religion, but women who had chosen another fetal diagnostic method were more interested in sex determination and in potential sex selection. Conclusions: Half of women and their partners wanted to know the fetal sex, and 5% were interested in sex selection. This high interest in sex determination is a challenge, since present national guidelines do not include sex determination as an option.

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  • 62.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Eurenius, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Emergency Contraceptive Pills in Sweden: Evaluation of an information campaign2004In: BJOG : an international journal of obstetrics and gynaecology, ISSN 1470-0328, Vol. 111, no 8, p. 820-827Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate a community-based intervention regarding emergency contraceptive pills, including a mass media campaign and information to women visiting family planning clinics.

    DESIGN: Quasi-experimental.

    SETTING: Two counties in Sweden.

    POPULATION: Eight hundred randomly selected women aged 16-30 years, 400 women in the intervention group and 400 in a comparison group.

    METHODS: Postal questionnaires before (2002) and after (2003) the intervention.

    MAIN OUTCOME MEASURES: Exposure to the intervention, knowledge, attitudes, practices and intention to use emergency contraceptive pills.

    RESULTS: Before the intervention, the response rate was 71% (n= 564); after the intervention, the corresponding figure was 83% (n= 467); overall response rate 58%. Two-thirds (64%) of the targeted women had noticed the information campaign. One out of six who had visited a family planning clinic during the intervention year recalled being given information about emergency contraceptive pills. Specific knowledge and attitudes improved over time in both groups, but there was no difference in change between the groups. The proportion of women who had used emergency contraceptive pills increased from 27% to 31% over time. Intention to use emergency contraceptive pills in case of need was reported by 74% of the women and remained stable over time, but logistic regression showed that information during the previous year contributed to willingness to use the method in the intervention group.

    CONCLUSIONS: Knowledge, attitudes and practices about emergency contraceptive pills increased in both groups. Emergency contraceptive pills is gradually becoming a more widely known, accepted and used contraceptive method in Sweden, a trend that may have limited the impact of the intervention.

  • 63.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Increased sexual risk taking behavior among Swedish female university students: repeated cross-sectional surveys2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 8, p. 966-970Article in journal (Refereed)
    Abstract [en]

    Background. The aim of this study was to perform a repeated cross-sectional study of female university students' sexual and contraceptive behavior, as well as experiences of pornography and sexual harassment and compare the findings with those from earlier studies. Methods. Waiting-room questionnaires to female university students (n = 315) visiting a Student Health Centre in Sweden. Similar investigations had been performed earlier, which enabled comparisons. Results. Almost all women (98%) had experienced intercourse and giving oral sex (94%). Condoms were most often used at first intercourse (72%) and combined oral contraceptives at latest intercourse (67%). The ever use of emergency contraceptive pills had increased from 22% to 52% over five years and there was a tendency towards more risk-taking behavior with more sexual partners (mean 5.4 in 1999 and mean 7.4 in 2004), more experience of first-date intercourse without a condom (37-45%), and more self-reported sexually transmitted infections (14-21%). The proportion of women who had undergone an abortion remained stable (6%) and fewer women reported ever being sexually harassed in 2004 compared to 1999. Conclusions. In conclusion, contraceptive use remained stable over time, but there was a trend towards more risky sexual behavior with more sexual partners, more unprotected first-date intercourse, and more self-reported sexually transmitted infections. Induced abortions, however, had not increased, but the use of emergency contraceptive pills had more than doubled in the five years between 1999 and 2004.

  • 64.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Häggström-Nordin, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Contraceptive use and associated factors among Swedish high school students2007In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 12, no 2, p. 119-124Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate self-reported sexual experiences, abortions, sexually transmitted infections (STIs), use of contraception and possible influencing factors on contraceptive use among Swedish high school students. Methods An anonymous classroom survey was distributed to a random sample (n = 924) of 18-year-old high school students in a medium-sized Swedish city. The response rate was 78% (n = 718). Results Three out of four students had experienced intercourse and the majority of them stated that they were satisfied with their sexual life. Few students reported having had an abortion (5%) or a STI (4%). Alcohol use appeared the most important contributing risk factor for non-use of contraception in relation to both first and latest intercourse, and the young men reported more unprotected latest intercourse than the young women did. Conclusion The fact that young men appear less inclined to use contraception is disturbing, and must be addressed in sexual education and individual counseling to promote a better sexual health for adolescents.

  • 65.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hanson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Häggström-Nordin, Elisabet
    Preventivt arbete behövs för att främja ungdomars sexuella hälsa2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 26-27, p. 1992-1995Article in journal (Refereed)
    Abstract [sv]

    Denna översiktsartikel har fokus på ungas sexualvanor ur perspektivet sexuellt överförda infektioner. Upprepade mätningar över tid tyder på förändrade sexualvanor, mer liberala attityder till tillfälliga sexuella förbindelser och ett ökat risktagande. Socioekonomi, könstillhörighet, alkohol- och pornografikonsumtion har samband med vissa sexuella aktiviteter och med grad av prevention mot sexuellt överförda infektioner och oönskad graviditet. Unga kvinnor förväntas bära huvudansvaret för prevention. Negativa attityder till att använda kondom och bristande kommunikation om preventivmedel hindrar effektiv prevention. Förebyggande arbete på bred front och med många aktörer behövs för att främja en god sexuell och reproduktiv hälsa. Sexualundervisning bör bearbeta attityder och öka förmågan till kritisk medieanalys och kommunikation kring sexualitet och prevention.

  • 66.
    Liljas Stålhandske, Maria
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Theology, Uppsala Religion and Society Research Centre.
    Makenzius, Marlene
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Existential experiences and needs related to induced abortion in a group of Swedish women: a quantitative investigation2012In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 33, no 2, p. 53-61Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the prevalence of existential experiences and needs among women involved in induced abortion.

    Methods: A questionnaire was used to collect information from 499 women requesting an induced abortion. A principle component analysis resulted in three components of existential experiences and needs, labelled: existential thoughts, existential practices, and humanisation of foetus. These components were analysed in relation to background data and other data from the questionnaire.

    Results: Existential experiences and needs were common. Existential thoughts about life and death, meaning and morality were related to abortion experience for 61% of women. Almost 50% of women, reported a need for special acts in relation to the abortion; and, 67% of women considered the pregnancy in terms of a child. A higher degree of existential components correlated to difficulty in making the abortion decision and poor psychological wellbeing after the abortion.

    Conclusion: Women’s experiences of abortion can include existential thoughts about life, death, meaning and morality, feelings of connectedness to the foetus, and the need for symbolic expression. This presents a challenge for abortion personnel, as the situation involves complex aspects beyond medical procedures and routines.

  • 67.
    Makenzius, Marlene
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gådin, Katja Gillander
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Romild, Ulla
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Male students' behaviour, knowledge, attitudes, and needs in sexual and reproductive health matters2009In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 14, no 4, p. 268-276Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate young male students' behaviour, knowledge, attitudes, and needs related to sexual and reproductive health (SRH). Differences between students on vocational and academic study programmes were also investigated. METHOD: A questionnaire consisting of 87 multiple choice questions was distributed to 253 male students attending three upper secondary schools in a single Swedish county. RESULTS: A response rate of 76% (n = 192) was achieved. Vocational students displayed more risk behaviour than those in academic study programmes regarding use of tobacco and sexual behaviour. Eighteen percent of those who were sexually experienced had suggested or provided the emergency contraception pill (ECP) to a girl. Insufficient knowledge of sexually transmitted infections (STIs) was identified, especially among the vocational students. No one reported the upper secondary school as their main source of knowledge and both groups requested more information about both genders' reproductive systems, and STIs. Some discriminatory attitudes regarding gender equality in SRH matters were identified. Both groups stated that male-friendly Youth Health Clinics (YHCs), easier access to condoms and Internet-service for Chlamydia test are important. CONCLUSIONS: Improvements in the quality and quantity of sex education in upper secondary schools are needed; they should be tailored to the spectrum of students' situations and needs. A structure of the YHC adapted to male youths' needs and alternative, easily accessible STI tests are important factors for reaching young men and having them participate in a responsible way in protecting their own and their partners' SRH.

  • 68.
    Makenzius, Marlene
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Swedish Natl Inst Publ Hlth, Ostersund, Sweden.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 27, no 1, p. 20-26Article in journal (Refereed)
    Abstract [en]

    Background: In public health efforts, knowledge about risk-groups is important for creating societal conditions to ensure good health on equal terms.

    Aim: To investigate differences in lifestyle and perceived health among 15-year-old teenagers with experience of sexual intercourse (self-defined) and same-aged teenagers without experience of sexual intercourse.

    Methods: A two-cluster questionnaire study among 15-year-old Swedish students (n = 2170) in 2009/10. Chi-squared test was used to identify differences between three groups: teenagers who had not had sexual intercourse; teenagers who had had sexual intercourse at age of 14 or younger; and teenagers who had had intercourse at an age of 15.

    Results: Thirty-two per cent (n = 334) of girls and 31% (n = 324) of boys had had sexual intercourse. Teenagers with experience of sexual intercourse at 15 years or younger used more tobacco, alcohol and illicit drugs than same-aged teenagers without intercourse experience did. Furthermore, teenagers with experience of intercourse, especially those with a debut at 14 year or younger, had less positive school experiences, more involvement in injuries and physical violence, were less (girls) and more (boys) physically active, and perceived a poorer health than teenagers without intercourse experience.

    Conclusion: Sexual intercourse at the age of 15 or younger is an indicator for a hazardous lifestyle and problematic life situation.

  • 69.
    Makenzius, Marlene
    et al.
    Department of Health Care Sciences, Mid Sweden University, Östersund, Sweden;b Department of Global Public Health, Karolinska institutet, Stockholm, Sweden.
    Obern, Cerisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Gemzell-Danielsson, Kristina
    Department of Women’s and Children’s Health, Karolinska University Hospital, Karolinska institutet, Stockholm, Sweden .
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Ekstrand Ragnar, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Women's decision-making related to induced abortion: a cross sectional study during a period of Covid-19 pandemic, in Sweden.2023In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 28, no 1, p. 44-50Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate women's decision-making on induced abortion.

    MATERIALS AND METHODS: A multi-centre cross-sectional survey among 623 abortion-seeking women in Sweden (2021). The perceived difficulty to decide on abortion was measured using a 7-point Likert scale, and analysed with univariate and multivariate analysis (odds ratios [OR], 95% confidence intervals [CI]).

    RESULTS: About half (n = 322;52%) scored 1-4, suggesting the decision was perceived as easier compared to those (n = 292;48%) who scored 5-7. Reasons for the abortion were: poor economy (n = 166;27%), too early in the relationship (n = 154;25.1%), want to work first (n = 147;23.9%), want to study first (n = 132;21.5%), uncertain about the relationship (104;16.9%), and too young (n = 104;16.9%). Predictors for perceiving the decision as difficult: partner's hesitance (OR = 3.18, CI:1.76-5.73), being born outside the Nordic countries (OR = 2.23, CI:1.28-3.87), having discussed the decision with someone (OR = 2.42, CI:1.67-3.50), age ≥30 (OR = 2.22, CI:1.03-4.76), the Covid-19 pandemic (OR = 2.08, CI:1.20-3.59), and the desire to have children in the future (OR = 1.96, CI:1.18-3.28). After confirmed pregnancy, poor mental well-being was more common among those who scored 5-7 (n = 140;47.9%) compared to those who scored 1-4 (n = 122;37.9), p = .029.

    CONCLUSION: Women's decision-making on abortion is complex; in times of crises, the decision procedure may be even more difficult. This valuable knowledge could be used to improve and promote satisfactory counselling beyond medical routines.

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  • 70.
    Makenzius, Marlene
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Autonomy and dependence: experiences of home abortion, contraception and prevention2013In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 3, p. 569-579Article in journal (Refereed)
    Abstract [en]

    Background:  Few studies have explored experiences and needs in relation to an induced medical abortion with the final treatment at home.

    Objective:  To explore women’s and men’s experiences and needs related to care in the context of a home abortion as well as to elicit their views on contraception and prevention of unwanted pregnancies.

    Method:  Qualitative interviews were carried out with 24 women and 13 men who had experienced a home abortion; they took place in Sweden during 2009/10.

    Results:  Two overarching themes were identified: Autonomy– the decision to undergo an abortion and the choice of method were well considered by the woman, supported by the partner. The home environment increased their privacy and control, which helped them freely express and share their emotions. They were motivated to avoid a subsequent abortion and considered it an individual responsibility; however, contraceptive follow-up visits were rare. Dependence– a desire to be treated with empathy and respect by care providers and to receive adequate information. In the prevention of unwanted pregnancies, financial resources, improved communication/education and subsidized contraceptives were considered important.

    Conclusion:  Home abortion increases autonomy, and women and partners demonstrate self-care ability. This autonomy, however, is related to dependence: a desire to be treated with empathy and respect on equal terms and to receive adequate information tailored to their self-care needs. Routines in abortion care should be continuously evaluated to ensure care satisfaction, safety and security as well as contraceptive adherence.

  • 71.
    Makenzius, Marlene
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Repeat induced abortion - a matter of individual behaviour or societal factors?: A cross-sectional study among Swedish women2011In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 16, no 5, p. 369-377Article in journal (Refereed)
    Abstract [en]

    Background: Almost 40% of all induced abortions in Sweden are repeat abortions; little is known about the risk factors.

    Objective: To investigate differences between women who had a first-time abortion and those with repeat abortion, and to identify factors associated with repeat abortion.

    Methods: A questionnaire was answered by 798 abortion-seeking women in Sweden during 2009. A regression model was used to assess risk factors for repeat abortions.

    Results: In the age range 20-49 years, 41% of women had experienced at least one previous abortion. Risk factors for repeat abortion were parity (OR 2.57), lack of emotional support (OR 2.09), unemployment or sick leave (OR 1.65), tobacco use (OR 1.56), and low educational level (OR 1.5). Some women (n = 55) considered economic support and work opportunities could have enabled them to continue the pregnancy. Increased Sex and Relationship Education (SRE), easy access to high-quality contraception and counselling, were suggested (n = 86) as interventions for preventing unintended pregnancies.

    Conclusions: Even in a country with long established SRE and a public health policy to enhance sexual and reproductive health over a third of women requesting abortion have experienced one previously and the rate is maintained. Some specific factors are identified but, overall, a picture of vulnerability among women seeking repeat abortion stands out that needs to be considered in the prevention of unintended pregnancies.

  • 72.
    Makenzius, Marlene
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Risk factors among men who have repeated experience of being the partner of a woman who requests an induced abortion2012In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 40, no 2, p. 211-216Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Prevention of unintended pregnancies is a public health objective; however, the profiles of male partners of women who choose to abort are relatively unexplored.

    OBJECTIVE:

    To investigate risk factors among men who have repeated experience of being the partner of a woman electing an induced abortion.

    METHODS:

    A questionnaire was used to collect information from 590 men recruited through their pregnant partner who applied for an abortion in Sweden during 2009. A binary logistic regression model assessed risk factors associated with repeated experience of abortion.

    RESULTS:

    One-third of the men had previous experience of a pregnant partner electing an induced abortion. Univariate analysis indicated these men were older, had a lower educational level and less emotional support, and were more often tobacco users than men for whom it was the first experience of a partner choosing to abort. Independent risk factors were being a victim of physical, psychological, or sexual violence or abuse over the past year (OR 2.62, 95% CI 1.36-5.08), unemployment or sick leave (OR 2.58, 95% CI 1.57-4.25), and having children (OR 2.00, 95% CI 1.22-3.28). The men suggested improved sex and relationship education in school and lower unemployment rates could prevent unintended pregnancies and abortions.

    Conclusions:

    Men with experience of repeat abortions present a picture of vulnerability that should be recognised in the prevention of unintended pregnancies. Increased work opportunities might be one important intervention to reduce the number of abortions.

  • 73.
    Makenzius, Marlene
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Sverige har Nordens höögsta aborttal: Oönskade graviditeter bör ses i helhetsperspektiv - individer, vård, samhålle2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 38, p. 1658-1661Article in journal (Other academic)
  • 74.
    Makenzius, Marlene
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Women and men's satisfaction with care related to induced abortion2012In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 17, no 4, p. 260-269Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate satisfaction with abortion care among women and their male partners, and to identify factors associated with high overall contentment with the care received.

    Methods A multi-centre cross-sectional questionnaire survey conducted in 2009 among 798 Swedish abortion-seeking women and 590 male partners was analysed with logistic regression.

    Results Overall care satisfaction was rated high by two-thirds (74%) of the women and half (52%) of the men. For women, factors associated with high overall satisfaction with care were: to be well treated by the health care staff (Odds Ratio [OR] = 11.78), sufficient pain relief (OR = 3.87), adequate information about the gynaecological examination (OR = 2.25), suitable contraceptive counselling (OR = 2.23), and ease of access to the clinic by phone (OR = 1.91). For men, the factors were to be well treated by the health care staff (OR = 5.32), and adequate information about the abortion procedure (OR = 2.64).

    Conclusion Most women and half of the men were pleased with the attention they had received, but one in four women and half the men were not, or not completely, suggesting improvement is needed, especially with regard to men. For both women and men the human aspect of the care, namely, the consideration showed by the attending staff, appears to be the most important factor associated with satisfaction regarding abortion care.

  • 75.
    Massae, Agnes Fredrick
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health. Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania .
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Pembe, Andrea Barnabas
    Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania .
    Mbekenga, Columba
    School of Nursing, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania .
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Patterns and predictors of fear of childbirth and depressive symptoms over time in a cohort of women in the Pwani region, Tanzania2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 11, article id e0277004Article in journal (Refereed)
    Abstract [en]

    Background: Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women and can negatively affect women during and after pregnancy. This study assessed patterns of FoB and DS over time and associations of postpartum FoB and DS with sociodemographic and obstetric characteristics.

    Methods: We conducted a longitudinal study at six health facilities in Tanzania in 2018-2019. Pregnant women were consecutively assessed for FoB and DS before and after childbirth using the Wijma Delivery Expectancy/Experience Questionnaire versions A & B and the Edinburgh antenatal and postnatal depressive scale. This paper is based on 625 women who completed participation.

    Results: The prevalence rates of FoB and DS during pregnancy were 16% and 18.2%, respectively, and after childbirth, 13.9% and 8.5%. Some had FoB (6.4%) and DS (4.3%) at both timepoints. FoB was strongly associated with DS at both timepoints (p < 0.001). Both FoB (p = 0.246) and DS (p < 0.001) decreased after childbirth. Never having experienced obstetric complications decreased the odds of postpartum and persisting FoB (adjusted odds ratio (aOR) 0.44, 95% confidence interval (CI) 0.23-0.83). Giving birth by caesarean section (aOR 2.01, 95% CI 1.11-3.65) and having more than 12 hours pass between admission and childbirth increased the odds of postpartum FoB (aOR 2.07, 95% CI 1.03-4.16). Postpartum DS was more common in women with an ill child/stillbirth/early neonatal death (aOR 4.78, 95% CI 2.29-9.95). Persisting DS was more common in single (aOR 2.59, 95% CI 1.02-6.59) and women without social support from parents (aOR 0.28, 95% 0.11-0.69).

    Conclusions: FoB and DS coexist and decrease over time. Identifying predictors of both conditions will aid in recognising women at risk and planning for prevention and treatment. Screening for FoB and DS before and after childbirth and offering psychological support should be considered part of routine antenatal and postnatal care. Furthermore, supporting women with previous obstetric complications is crucial. Using interviews instead of a self-administered approach might have contributed to social desirability. Also, excluding women with previous caesarean sections could underestimate FoB and DS prevalence rates.

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  • 76.
    Massae, Agnes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health. Muhimbili Univ Hlth & Allied Sci, Dept Community Hlth Nursing, POB 65001, Dar Es Salaam, Tanzania..
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Leshabari, Sebalda
    Muhimbili Univ Hlth & Allied Sci, Dept Community Hlth Nursing, POB 65001, Dar Es Salaam, Tanzania..
    Mbekenga, Columba
    Hubert Kairuki Mem Univ, Fac Nursing & Midwifery, Dar Es Salaam, Tanzania..
    Pembe, Andrea B.
    Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Fear of childbirth: validation of the Kiswahili version of Wijma delivery expectancy/experience questionnaire versions A and B in Tanzania2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, article id 882Article in journal (Refereed)
    Abstract [en]

    Background: Fear of childbirth is common both before and after childbirth, often leading to complications in mother and new-born. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) are commonly used to measure fear of childbirth among women before (version A) and after childbirth (version B). The tools are not yet validated in the Tanzanian context. This study aimed to validate the reliability, validity, and factorial structure of their Kiswahili translations.

    Methods: A longitudinal study was conducted in six public health facilities in the Pwani region, Tanzania. In all, 694 pregnant and 625 postnatal women were concurrently selected and responded to W-DEQ-A and W-DEQ-B. Validation involved: translating the English questionnaires into Kiswahili; expert rating of the relevancy of the Kiswahili versions' items; computing content validity ratio; piloting the tools; data collection; statistical analysis with reliability evaluated using Cronbach's alpha and the intraclass correlation coefficient. Tool validity was assessed using factor analysis, convergent and discriminant validity. Exploratory factor analysis and confirmatory factor analysis were conducted on data collected using W-DEQ-A and W-DEQ-B, respectively.

    Results: Exploratory factor analysis revealed seven factors contributing to 50% of the total variation. Four items did not load to any factor and were deleted. The factors identified were: fear; lack of self-efficacy; lack of positive anticipation; isolation; concerns for the baby; negative emotions; lack of positive behaviour. The factors correlated differently with each other and with the total scores. Both Kiswahili versions with 33 items had good internal consistency, with Cronbach's alphas of .83 and .85, respectively. The concerns for the baby factor showed both convergent and discriminant validity. The other six factors showed some problems with convergent validity. The final model from the confirmatory factor analysis yielded 29 items with good psychometric properties (chi(2)/df = 2.26, p = < .001, RMSEA = .045, CFI = .90 and TLI = .81).

    Conclusions: The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable tools and measure fear of childbirth with a multifactorial structure, encompassing seven factors with 29 items. They are recommended for measuring fear of childbirth among pregnant and postnatal Tanzanian women. Further studies are needed to address the inconsistent convergent validity in the revised versions and assess the psychometric properties of W-DEQ-A among pregnant women across gestational ages.

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  • 77.
    Massae, Agnes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.;Muhimbili Univ Hlth & Allied Sci, Dept Community Hlth Nursing, Dar Es Salaam, Tanzania..
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Leshabari, Sebalda
    Muhimbili Univ Hlth & Allied Sci, Dept Community Hlth Nursing, Dar Es Salaam, Tanzania..
    Mbekenga, Columba
    Aga Khan Univ, Sch Nursing & Midwifery, Dar Es Salaam, Tanzania..
    Pembe, Andrea Barnabas
    Muhimbili Univ Hlth & Allied Sci, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania2021In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 21, no 1, article id 704Article in journal (Refereed)
    Abstract [en]

    Background Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors. Methods A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40 weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored >= 66 and >= 10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS. Results The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43-27.84] and in single mothers (AOR 2.57, 95%CI 1.14-5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05-0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09-0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12-5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38-3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31-4.08). Conclusions Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to offer support during pregnancy and childbirth.

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  • 78.
    Mattebo, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Grün, Nathalie
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Centre of Clinical Research Västerås, Uppsala University, Central Hospital, Västerås.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Häggström-Nordin, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Dalianis, Tina
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Sexual experiences in relation to HPV vaccination status in female high school students in Sweden2014In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 19, no 2, p. 86-92Article in journal (Refereed)
    Abstract [en]

    Objectives

    To investigate sexual experiences, sexually transmitted infections (STIs) and use of condoms in relation to human papillomavirus (HPV)-vaccination status in female high school students.

    Methods

    In 2013, 355 female students with a median age of 18 years from randomly selected high schools in Sweden answered a classroom questionnaire on sexual experiences and HPV-vaccination status.

    Results

    In total 227/348 (65%) of the women reported having received at least one HPV vaccine dose. Median age at first intercourse was 15 and 16 years respectively, in the 141/227 (62%) vaccinated after, and the 86/227 (38%) vaccinated before their sexual debut. There were no differences between the HPV-vaccinated and non-vaccinated groups regarding condom use, STIs, and experiences of oral and anal sex, or friends- with-benefit relationships. However, having had sexual intercourse and 'one-night stands' were more common in the vaccinated group (both p < 0.05).

    Conclusion

    Many students (62%) were vaccinated against HPV, with two-thirds after their sexual debut. There were no differences in condom use and STIs, and only a few differences in sexual experiences between the HPV-vaccinated and non-vaccinated groups. Initiating HPV vaccination before sexual debut is important, as is information about the link between HPV, sexual behaviour and cancer.

  • 79.
    Mattebo, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Häggström-Nordin, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Akademin för Hälsa, Vård och Välfärd, Mälardalens Högskola, Västerås.
    Professionals’ perceptions of the effect of pornography on Swedish adolescents2014In: Public Health Nursing, ISSN 0737-1209, E-ISSN 1525-1446, Vol. 31, no 3, p. 196-205Article in journal (Refereed)
    Abstract [en]

    Objective:The aims were to gain a deeper understanding of how personnel, who work with adolescents, reason about the effect of pornography and its spread in the media, and to explore how well prepared they consider themselves to be in addressing sexual health and gender equality.

    Design and Sample: An inductive, exploratory, qualitative study with focus group discussions was selected. Seventeen participants with different professions were invited into five heterogeneous groups.

    Measures: Data were analyzed according to grounded theory. Results: Conflicting messages about sexuality became the core category. Participants were of the opinion that pornography conveyed a contradictory message compared with national public health goals, societal laws, and regulations. They believed that young people use pornography as a source of information and stimulation. Furthermore, they thought that pornography contributed to norm-creating ideals and a demanding sexuality, thus, confirming the traditional gender order. The participants opined that a professional approach was required when addressing sexuality and gender equality issues and requested better training tools and more cultural competence.

    Conclusions: Professionals working with adolescents perceived that pornography conveys a conflicting message about sexuality. They expressed a need for adequate tools for improving education on health and sexuality, including gender equality aspects and critical media analysis.

  • 80.
    Mattebo, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Olsson, Tove
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Häggström-Nordin, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hercules and Barbie?: Reflections on the influence of pornography and its spread in the media and society in groups of adolescents in Sweden2012In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 17, no 1, p. 40-49Article in journal (Refereed)
    Abstract [en]

    Objectives

    To describe and get a deeper understanding of how groups of young women and men reflect on and discuss pornography and its spread in the media and society, and its possible influence on sexual behaviour and relationships.

    Methods

    Six focus group interviews were conducted with teenagers, three with women (n = 17) and three with men (n = 18). Open questions about pornography and its spread in the media and society were discussed. The interviews were tape-recorded and transcribed verbatim. Data were analysed according to Grounded Theory.

    Results

    The core category 'A discriminatory sexuality' illustrates how participants felt regarding the messages conveyed by pornography portraying a man's role as dominant and a woman's role as subordinate. Pornographic messages were described as 'Fiction' depicting a distorted reality. Feelings of ambivalence towards pornography were expressed: anxiety and fear, but also inspiration. Participants said pornography occurred everywhere in the media and society, and felt pressured by messages relating to looks and sexual techniques.

    Conclusions

    Pornography and its spread in the media and society were considered as presenting a discriminatory image of body ideals, sexuality and relationships. Despite this awareness, both men and women considered pornography as sources of knowledge and inspiration: an apparent paradox.

  • 81.
    Mattebo, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Häggström-Nordin, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Akademin för Hälsa, Vård och Välfärd, Mälardalens Högskola, Västerås.
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Centrum för klinisk forskning, Västmanlands sjukhus, Västerås.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Pornography and sexual experiences among high school students in Sweden2014In: Journal of Developmental and Behavioral Pediatrics, ISSN 0196-206X, E-ISSN 1536-7312, Vol. 35, no 3, p. 179-188Article in journal (Refereed)
    Abstract [en]

    Objectives:

    The study investigated the differences between high school boys and girls in: 1) use of pornography, 2) sexual experiences, 3) experience of sexual abuse, and 4) perceptions of sexuality and pornography. It also examined possible predictors of experiencing sexual activities, such as: sex, sociodemographic factors (high school program, household, and ethnic background), pornography consumption, experience of sexual abuse, perception of sexuality, and perception of pornography.

    Method:

    A population-based classroom survey of 16-year-old boys (n = 477) and girls (n = 400) from 53 randomly selected high school classes in two towns in mid-Sweden.

    Results:

    Almost all boys (96%, n = 453) and 54% of the girls (n = 213) had watched pornography. Regardless of sex, pornography consumers had a positive perception of pornography. There were no differences between pornography-consuming boys and girls regarding fantasies and attempted sexual acts inspired by pornography. A higher proportion of girls (15%) than boys (6%) had experienced sexual abuse. Predictors for being sexually experienced (oral sex, intercourse, and anal sex) included: being a girl, attending a vocational high school program, living with separated parents, having experience of sexual abuse, stating that boys and girls are equally interested in sex, and having a positive perception of pornography (Adj R2 = 0.145).

    Conclusion:

    Boys had more experience of and a more positive perception of pornography but there were only a few differences between boys and girls in the pornography-consumer group. Girls were more sexually experienced than boys. A positive perception of pornography predicted being sexually experienced.

  • 82.
    Mattebo, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Häggström-Nordin, Elisabet
    Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden.
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Pornography consumption and psychosomatic and depressive symptoms among Swedish adolescents: a longitudinal study2018In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 4, p. 237-246Article in journal (Refereed)
    Abstract [en]

    Background: The aims of this longitudinal study were to identify predictors for continued pornography consumption and to investigate pornography consumption in relation to psychosomatic and depressive symptoms among a group of adolescents in Sweden.

    Methods and materials: A longitudinal study in classroom environment in 53 randomly selected senior high school classes in mid-Sweden in years 2011 and 2013. Out of 477 participating boys and 400 girls in 2011, 224 boys (47%) and 238 girls (60%) participated in 2013.

    Results: Higher pornography consumption at baseline and being born outside Sweden predicted continued pornography consumption at follow-up (adjusted R2 = 0.689).

    Psychosomatic symptoms at follow-up were predicted by higher pornography consumption at baseline (adjusted R2 = 0.254), being a girl, living with separated parents, and attending a vocational high school program. By contrast, depressive symptoms at follow-up were predicted by less pornography consumption at baseline (adjusted R2 = 0.122) and being a girl.

    Conclusions: Pornography consumption may, for some individuals, be associated to mental health issues. Differences between teenage boys and girls and between adolescents with diverse ethnic backgrounds imply that counseling and discussion about pornography need to be adjusted and individualized.

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  • 83.
    Mattebo, Magdalena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Häggström-Nordin, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nilsson, Kent W
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Pornography consumption, sexual experiences, lifestyles, and self-rated health among male adolescents in Sweden2013In: Journal of Developmental and Behavioral Pediatrics, ISSN 0196-206X, E-ISSN 1536-7312, Vol. 34, no 7, p. 460-468Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE

    To describe patterns of pornography use among high school boys and to investigate differences between frequent, average, and nonfrequent users of pornography with respect to sexual experiences, lifestyles, and self-rated health.

    METHODS

    A population-based classroom survey among 16-year-old boys (n = 477), from 53 randomly selected high school classes in 2 towns in mid-Sweden.

    RESULTS

    Almost all boys, 96% (n = 453), had watched pornography. Frequent users of pornography (everyday) (10%, n = 47) differed from average users (63%, n = 292) and nonfrequent users (27%, n = 126). Frequent users versus average users and nonfrequent users had more sexual experiences, such as one night stands (45, 32, 25%, respectively) and sex with friends more than 10 times (13, 10, 2%). A higher proportion of frequent users spent more than 10 straight hours at the computer several times a week (32, 5, 8%) and reported more relationship problems with peers (38, 22, 21%), truancy at least once a week (11, 6, 5%), obesity (13, 3, 3%), use of oral tobacco (36, 29, 20%), and use of alcohol (77, 70, 52%) versus average and nonfrequent users. One third of frequent users watched more pornography than they actually wanted. There were no differences between the groups regarding physical and psychological self-rated health.

    CONCLUSIONS

    The boys, defined as frequent users of pornography, were more sexually experienced, spent more time at the computer, and reported an unhealthier lifestyle compared with average and nonfrequent users. No differences regarding self-rated health were detected even though obesity was twice as common among frequent users.

  • 84.
    Målqvist, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Hultstrand, Jenny Niemeyer
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    KC, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    High levels of unmet need for family planning in Nepal.2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, p. 1-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Providing access to family planning services is a basic component and a cost-effective intervention to reduce maternal mortality worldwide. It is closely linked to women's decision-making power and female emancipation. Unmet need for family planning is thus an indicator going beyond maternal health with far reaching societal implications. This study examines the level of unmet need for family planning in Nepal and its distribution along structural determinants.

    METHODS: Data from the Multiple Indicator Cluster Survey 2014 was utilized for analysis. Prevalence of unmet need for family planning was calculated and logistic regression models used to ascertain inequity.

    RESULTS: A total unmet need for family planning of 40.9% among the 10,688 included women was observed. No major differences between socioeconomic groups could be detected, except for a somewhat higher rate of unmet need among the least educated. Total fertility rate among the women included was 2.59. Contraceptive use among adolescents was alarmingly low, with almost none reporting using any type of contraception.

    CONCLUSION: The lack of major inequity implies that the high level of unmet need for contraception is a general problem in society and must be addressed broadly. A special focus on education and provision for adolescents is needed in Nepal.

  • 85.
    Naessén, Tord
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Non-Invasive High-Frequency Ultrasound Using Intima And Intima/Media Thickness Ratio (But Not CIMT), Correctly Monitored Expected Beneficial Vascular Effects Of Menopausal Hormone Therapy2016In: ATHEROSCLEROSIS, ISSN 0021-9150, Vol. 252, p. E192-E193Article in journal (Refereed)
  • 86.
    Niemeyer Hultstrand, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Global Health Research on Implementation and Sustainability.
    Ekstrand Ragnar, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Foreign-born women’s lifestyle and health before and during early pregnancy in Sweden2020In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 25, no 1, p. 20-27Article in journal (Refereed)
    Abstract [en]

    Objectives: The aims of the study were to investigate foreign-born women’s lifestyle and health before and during early pregnancy and compare them with those of Nordic-born women.

    Methods: Women recruited at antenatal clinics in Sweden answered a questionnaire in Swedish, English or Arabic or by telephone interview with an interpreter. Questions covered pregnancy planning and periconceptional lifestyle and health. The responses of women born in or outside Europe were compared with those of Nordic-born women. The impact of religiousness and integration on periconceptional lifestyle and health was also investigated.

    Results: Twelve percent of participants (N = 3389) were foreign-born (n = 414). Compared with Nordic women, European and non-European women consumed less alcohol before conception (respectively, adjusted odds ratio [aOR] 0.38; 95% confidence interval [CI] 0.24, 0.58 and aOR 0.14; 95% CI 0.10, 0.19) and during early pregnancy (respectively, aOR 0.61; 95% CI 0.40, 0.91 and aOR 0.20; 95% CI 0.14, 0.29). Non-European women used less tobacco and were less physically active, but body mass index (BMI) did not differ between groups. Self-perceived health, stress and anxiety during early pregnancy did not differ, but non-European women more often had depressive symptoms (aOR 1.67; 95% CI 1.12, 2.51). Non-European women’s healthy lifestyle was associated with religiousness but not with the level of integration.

    Conclusions: Non-European women were overall less likely to engage in harmful lifestyle habits before and during early pregnancy but were more likely to suffer from depressive symptoms in comparison with Nordic women.

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  • 87.
    Niemeyer Hultstrand, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Törnroos, Elin
    Gemzell-Danielsson, Kristina
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Makenzius, Marlene
    Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden..
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ekstrand Ragnar, Maria
    Uppsala Univ, Dept Womens & Childrens Hlth, S-75185 Uppsala, Sweden.;Lund Univ, Dept Hlth Sci, Lund, Sweden..
    Induced abortion and access to contraception in Sweden during the COVID-19 pandemic2022In: BMJ Sexual & Reproductive Health, ISSN 2515-1991, E-ISSN 2515-2009, Vol. 48, no 4, p. 311-312Article in journal (Other academic)
  • 88.
    Niemeyer Hultstrand, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Törnroos, Elin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Makenzius, Marlene
    Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden.;Mid Sweden Univ, Dept Hlth Sci, Östersund, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Gemzell-Danielsson, Kristina
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Karolinska Univ Hosp, WHO Ctr, Stockholm, Sweden..
    Sundström-Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Ekstrand Ragnar, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Lund Univ, Dept Hlth Sci, Lund, Sweden.
    Contraceptive use among women seeking an early induced abortion in Sweden2023In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 102, no 11, p. 1496-1504Article in journal (Refereed)
    Abstract [en]

    Introduction

    In spite of societal efforts to strengthen women's sexual and reproductive health in Sweden, many women have unmet contraceptive needs and the abortion rate remains high. The aim of this study was to investigate contraceptive use among abortion-seeking women.

    Material and methods

    Swedish-speaking women seeking an induced abortion up to the end of gestational week 12 at seven hospitals filled out an anonymous paper questionnaire between January and June 2021. Data were analyzed using frequencies and cross-tabulations, and the Chi-square test was used to compare age-groups. Valid percentages are presented.

    Results

    In total, 623 women participated. Median age was 29 years and 13% were born outside the Nordic countries. In the year preceding the abortion, condoms (37%, n = 228) were the most commonly used contraceptive method, followed by short-acting reversible contraception (SARC) (35%, n = 213) and withdrawal (25%, n = 152). Around one in five (n = 113) had not used any method in the year preceding the abortion. Sixteen percent (n = 96) had changed contraceptive method in the last year. At the time around conception, 15% (n = 90) reported use of SARC and 2% (n = 12) of long-acting reversible contraception (LARC). Four out of 10 women (n = 268) reported non-use of contraception at the time around conception, with a higher proportion among adolescents (70%, n = 30, P = 0.001). Among the women who responded to why they had not used any method (n = 387), the main reasons were that they did not believe they could become pregnant at that time (37%, n = 144) or had negative experiences from using contraceptives (32%, n = 123). A majority (88%, n = 527) planned to use contraception after the abortion. Of the women who had decided on method, 55% (n = 271) planned to use LARC, and 38% (n = 188) planned to use SARC.

    Conclusion

    The unmet need for contraception appears to be high among abortion-seeking women in Sweden. Many had discontinued contraception use during the last year, and the main reasons for avoidance were beliefs that one could not become pregnant and negative experiences of contraceptives. The underestimation of pregnancy risk indicates limited fertility awareness, thus our recommendation would be to strengthen the sexual and reproductive knowledge among this group.

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  • 89. Nordfors, Cecilia
    et al.
    Grun, Nathalie
    Haeggblom, Linnea
    Tertipis, Nikolaos
    Sivars, Lars
    Mattebo, Magdalena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Häggström-Nordin, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). 3School of Health, Care and Social Welfare, Mälardalen University, Västerås.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Ramqvist, Torbjorn
    Dalianis, Tina
    Oral human papillomavirus prevalence in high school students of one municipality in Sweden2013In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 45, no 11, p. 878-881Article in journal (Refereed)
    Abstract [en]

    The rise in human papillomavirus (HPV) infection has been suggested to be responsible for the increased incidence of oropharyngeal cancer in the Western world. This has boosted interest in oral HPV prevalence and whether HPV vaccines can prevent oral HPV infection. In a previous study we showed oral HPV prevalence to be almost 10% in youth aged 15-23 y attending a youth clinic in Stockholm, Sweden. However, this may not be a generalizable sample within the Swedish population. Therefore, mouthwashes were used to investigate oral HPV prevalence in 335 Swedish high school students aged 17-21 y (median age 18 y), from 1 municipality with 140,000 inhabitants. The presence of HPV DNA in the oral samples, as examined by a Luminex-based assay, was significantly lower in this cohort, only 1.8% (3.1% in females and 0.6% in males), as compared to our previous study.

  • 90.
    Obern, Cerisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Ekstrand Ragnar, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Department of Health Sciences, Lund University, Lund, Sweden.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Niemeyer Hultstrand, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Gemzell-Danielsson, Kristina
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; WHO centre, KarolinskaUniversity Hospital, Stockholm, Sweden.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Makenzius, Marlene
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Department ofHealth Sciences, Mid Sweden University, Östersund, Sweden.
    Multiple induced abortions: implications for counselling and contraceptive services from a multi-centre cross-sectional study in Sweden2023In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 28, no 2, p. 119-124Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate factors associated with multiple induced abortions.

    Materials and methods: A multi-centre cross-sectional survey among abortion-seeking women (n?=?623;14-47y) in Sweden, 2021. ?Multiple abortions? was defined as having had ≥2 induced abortions. This group was compared to women with a previous experience of 0-1 induced abortion. Regression analysis was conducted to determine independent factors associated with multiple abortions.

    Results: 67.4% (n?=?420) reported previous experience of 0-1 abortion, and 25.8% (n?=?161) ≥2 abortions (42 women chose to not respond). Several factors were associated with multiple abortions, but when adjusted in the regression model, the following factors remained; parity ≥1 (OR = 2.96, 95%CI [1.63, 5.39]), low education (OR = 2.40, 95%CI [1.40, 4.09]), tobacco use (OR = 2.50, 95%CI [1.54, 4.07]) and exposure to violence over the last year (OR = 2.37, 95%CI [1.06, 5.29]). More women in the group who had 0-1 abortion (n?=?109/420) believed they could not become pregnant at the time of conception, compared to women who had ≥2 abortions (n?=?27/161), p=.038. Mood swings, as a contraceptive side-effect, were more often reported among women with ≥2 abortions (n?=?65/161), compared to those with 0-1 abortion (n?=?131/420), p=.034.

    Conclusion: Multiple abortions is associated with vulnerability. Sweden provides high quality and accessible comprehensive abortion care; however, counselling must be improved both to achieve contraceptive adherence and identify and address domestic violence.

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  • 91.
    Palmqvist, Hanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Zather, Josefine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Fathers' and co-mothers' voices about breastfeeding and equality - A Swedish perspective2015In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 28, no 3, p. E63-E69Article in journal (Refereed)
    Abstract [en]

    Background: Breastfeeding has benefits for mother and child and the partner's support influences the decision as well as the duration of breastfeeding. The aim of this study was to describe partners' knowledge and feelings regarding breastfeeding and how they reason about equality and involvement during the lactation period. Methods: A qualitative study using semi-structured interviews with 7 male and 2 female partners (labelled co-mothers) of breastfeeding mothers. The interviews were transcribed and analysed using a phenomenological approach. Results: The main theme Wish for the child to be breastfed/get breast milk described the informants' desire that their child was breastfed and this desire was based on knowledge of benefits of breastfeeding but also on intuitive feelings of breastfeeding as something natural. The main theme Effect of breastfeeding on fathers/co-mothers described how breastfeeding affected the informants and their relationship to the child and the mother in different ways. The main theme Adaptation and acceptance described how informants accepted the impact that breastfeeding had and/or adapted to it and continued to wish for the child to receive breast milk. Conclusion: The informants desired that their children be breastfed/get breast milk. Breastfeeding affected the informants in different ways, which they handled by adapting to and accepting the situation, and they expressed a continued desire that their children be breastfed/get breast milk. Parental classes should include both parents to be and address how breastfeeding can be successfully performed and supported without threatening the equality between the parents.

  • 92. Shawe, Jill
    et al.
    Delbaere, Ilse
    Ekstrand, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hegaard, Hanne Kristine
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Mastroiacovo, Pierpaolo
    Stern, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Steegers, Eric
    Stephenson, Judith
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom2015In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 20, no 2, p. 77-87Article in journal (Refereed)
    Abstract [en]

    Objectives Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. Methods In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. Results All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. Conclusions Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population.

  • 93.
    Sjömark, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health. Karolinska Inst, Ctr Psychotherapy Educ & Res, Stockholm Hlth Care Serv, Stockholm Cty Council, Liljeholmstorget 7B, SE-11364 Stockholm, Sweden;Karolinska Inst, Dept Clin Neurosci, Liljeholmstorget 7B, SE-11364 Stockholm, Sweden.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    A longitudinal, multi-centre, superiority, randomized controlled trial of internet-based cognitive behavioural therapy (iCBT) versus treatment-as-usual (TAU) for negative experiences and posttraumatic stress following childbirth: the JUNO study protocol2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 387Article in journal (Refereed)
    Abstract [en]

    Background: About one-third of women report their childbirth as traumatic and up to 10% have severe traumatic stress responses to birth. The prevalence of Posttraumatic stress disorder following childbirth (PTSD FC) is estimated to 3%. Women with PTSD FC report the same symptoms as other patients with PTSD following other types of trauma. The effect of psychological treatment for women with PTSD FC has only been studied in a few trials. Similarly, studies on treatment needs for women not diagnosed as having PTSD FC but who nevertheless face psychological problems are lacking. Methods/design: Women who rate their overall birth experience as negative on a Likert scale, and/or had an immediate caesarean section and/or a major postpartum haemorrhage are randomized to either internet delivered cognitive behaviour therapy (iCBT) plus treatment as usual (TAU) or TAU. The iCBT is to be delivered in two steps. The first step consists of six weekly modules for both the woman and her partner (if they wish to participate) with minimal therapeutic support. Step 2 consists of eight weekly modules with extended therapeutic support and will be offered to participants whom after step 1 report PTSD FC. Assessments will be made at baseline, 6 weeks, 14 weeks, and at follow-ups at 1, 2, 3 and 4 years after baseline. The primary outcome measures are symptoms of posttraumatic stress and depression. Secondary outcomes are quality of life, parent-child bonding, marital satisfaction, coping strategies, experience regarding the quality of care received, health-related quality of life, number of re-visits to the clinic and number of appointments for counselling during the 4 years' period after the negative childbirth experience, time until the woman gets pregnant again, and the type of birth in the subsequent pregnancy. A health economic evaluation in the form of a cost utility analysis will be conducted. Discussion: This study protocol describes a randomized controlled trial that will provide information about the effectiveness of iCBT in women with negative experiences, posttraumatic stress, and PTSD FC.

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  • 94.
    Sjömark, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Viirman, Frida
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health. Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Region Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Effect of internet-based cognitive behaviour therapy among women with negative birth experiences on mental health and quality of life: a randomized controlled trial2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, article id 835Article in journal (Refereed)
    Abstract [en]

    Background: Giving birth is often a positive experience, but 7-44% have negative experiences and about 4% develop posttraumatic stress disorder following childbirth (PTSD FC). This randomized controlled trial (RCT) investigated the effect of internet-based cognitive behaviour therapy (iCBT) for women with negative birth experiences and/or at risk for PTSD FC.

    Methods: This was a superiority nonblinded multicentre RCT comparing iCBT combined with treatment as usual (TAU) with TAU only. Data were collected through questionnaires at baseline, at 6 weeks, 14 weeks and 1 year after randomization. The RCT was conducted at four delivery clinics in Sweden and participants were recruited from September 2013 until March 2018. Women who rated their childbirth experience as negative on a Likert scale, and/or had an immediate caesarean section or a haemorrhage of > 2000 ml were eligible. Primary outcomes were symptoms of posttraumatic stress (Traumatic Event Scale, TES) and symptoms of depression (Edinburgh Postnatal Depression Scale, EPDS). Secondary outcomes were satisfaction with life (Satisfaction With Life Scale, SWLS) and coping (Ways of Coping Questionnaire, WCQ).

    Results: Out of 1810 eligible women, 266 women were randomised to iCBT+TAU (n = 132) or to TAU (n = 134). In the iCBT+TAU group 59 (45%) completed the treatment. ICBT+TAU did not reduce PTSD FC at 6 weeks, at 14 weeks, or at 1 year follow-up compared with TAU, according to the TES. Both the ITT and completer analyses showed significant time and quadratic time effects due to reduction of symptoms in both groups on the TES (re-experience subscale) and on the EPDS, and significant time effect on the self-controlling subscale of the WCQ (which increased over time). There was also a significant main effect of group on the SWLS where the TAU group showed higher initial satisfaction with life. Exploratory subgroup analyses (negative birth experience, immediate caesarean section, or severe haemorrhage) showed significant time effects among participants with negative birth experience on re-experience, arousal symptoms and depressive symptoms.

    Conclusions: The ICBT intervention did not show superiority as both groups showed similar beneficial trajectories on several outcomes up to 1 year follow-up. This intervention for women with negative birth experiences and/or at risk for PTSD FC was feasible; however, the study suffered from significant drop out rate. Future studies with more narrow inclusion criteria and possibly a modified intervention are warranted.

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  • 95.
    Sjömark, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Viirman, Frida
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Clinical Obstetrics.
    Parling, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Reproductive Health. Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Stockholm, Sweden.;Stockholm Hlth Care Serv Reg Stockholm, Stockholm, Sweden..
    Antepartum and labour-related single predictors of non-participation, dropout and lost to follow up in a randomised controlled trial comparing internet-based cognitive-behaviour therapy with treatment as usual for women with negative birth experiences and/or post-traumatic stress following childbirth2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 11, article id e063214Article in journal (Refereed)
    Abstract [en]

    Objectives: Internet-based interventions are often hampered by high dropout rates. The number of individuals who decline to participate or dropout are reported, but reasons for dropout are not. Identification of barriers to participation and predictors of dropout may help improve the efficacy of internet-based clinical trials. The aim was to investigate a large number of possible predictors for non-participation and dropout in a randomised controlled trial for women with a negative birth experience and/or post-traumatic stress following childbirth.

    Setting: A childbirth clinic at a university hospital in Sweden.

    Participants: The sample included 1523 women who gave birth between September 2013 and February 2018. All women who rated an overall negative birth experience on a Likert scale, and/or had an immediate caesarean section (CS), and/or severe postpartum haemorrhage (& GE; 2000 mL) were eligible.

    Methods: Demographic, antepartum, and labour-related/postpartum predictors were investigated for non-participation (eligible but denied participation), pre-treatment dropout (prior to intervention start), treatment dropout, and loss to follow-up. Descriptive statistics and logistic regression were used in the data analysis.

    Results: A majority (80.3 %) were non-participants. Non-participation was predicted by lower level of education, being foreign-born, no experience of counselling for fear of childbirth, multiparity, vaginal delivery (vs CS and vacuum-assisted delivery) and absence of: preeclampsia, anal sphincter injury and intrapartum fetal distress. Pretreatment dropout was predicted by the absence of severe haemorrhage. Treatment dropout was predicted by vaginal delivery (vs immediate CS), vertex presentation and good overall birth experience. Loss to follow-up was predicted by vaginal delivery (vs immediate CS or vacuum-assisted delivery) and absence of intrapartum fetal distress.

    Conclusions: Mothers with no obstetric complications were more likely to not participate and dropout at different time points. Both demographic, antepartum and obstetrical variables are important to attend to while designing procedures to maximise participation in internet-delivered cognitive-behavioral therapy.

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  • 96.
    Sköld, Annelie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Contraceptive use during the reproductive lifecycle as reported by 46-year-old women in Sweden2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 1, p. 43-47Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to investigate the contraceptive methods 46-year-old women in Sweden had chosen during different phases of their reproductive lifecycle and, the factors affecting their choice. Study design: The design was a retrospective cross-sectional study and targeted 46-year-old women. Five hundred Swedish women were randomly selected from a national population-based register and sent a questionnaire with 18 multiple response questions: the response rate was 47%. Results: The women used different contraceptive methods during different phases of their reproductive lifecycle. Women mainly used oral contraceptive pills and condoms before pregnancy, copper-IUD between pregnancies and, hormonal- and copper IUD after pregnancy. Condoms were used during all phases of women's fertile period. Women with early sexual debut were more likely to have used condom as their first contraceptive method than women with late sexual debut, and women who had children were more likely to use IUD as current contraception than women without children. High efficacy, accessibility and advice from a counselor were the most cited reasons for choosing a particular method. The most common reasons for discontinuing contraceptive use were a wish to be pregnant and concerns about side effects. The partner had little or no influence on choice of method, but advice from a gynecologist or midwife was influential. Conclusions: 46-year-old women in Sweden had chosen different contraceptive methods during different phases of their reproductive lifecycle. Partners appear to have limited influence over this choice. Individualized counseling by health care providers seems important.

  • 97.
    Stenhammar, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Ehrsson, Ylva Tiblom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Åkerud, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Sexual and contraceptive behavior among female university students in Sweden: repeated surveys over a 25-year period2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 3, p. 253-259Article in journal (Refereed)
    Abstract [en]

    ObjectiveTo study female students' sexual and contraceptive behavior and compare these results with earlier surveys. DesignComparative, repeated cross-sectional surveys, started in 1989 and repeated every fifth year. SettingContraceptive counseling delivered at a Student Health Center in Sweden. PopulationFemale university students (n=359). MethodsMultiple-choice waiting-room questionnaire. Main outcome measuresSexual and contraceptive behavior. ResultsIn 1989, age at first intercourse was 17.6years vs. 16.7years in 2014, number of lifetime sexual partners was 4.0 vs. 12.1 in 2014, and number of sexual partners during the previous 12months was 1.0 vs. 2.8 in 2014. Condom use during first intercourse with the latest partner decreased from 49% to 41% (n=172 in 2009 vs. n=148 in 2014: p<0.001), and experience of anal sex increased from 39% to 46% (n=136 in 2009 vs. n=165 in 2014: p=0.038), and 25% (n=41 in 2014) always used a condom during anal sex. A total of 70% (n=251) made use of pornography, and 48% (n=121) considered their sexual behavior affected by pornography. Eighty-nine percent (n=291) wanted two to three children and 9% (n=33) had thought about freezing eggs for the future. The female students' knowledge about increasing age being correlated with decreased fertility varied. ConclusionsSexual behavior among female university students has gradually changed during the last 25years and behavior appears more risky today. As this may have consequences on future reproductive health, it is vital to inform women about consistent and correct condom use and about the limitations of the fertile window.

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  • 98.
    Stern, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bodin, Maja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Grandahl, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Segeblad, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Axen, L.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Tyden, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Midwives' adoption of the reproductive life plan in contraceptive counselling: a mixed methods study2015In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 30, no 5, p. 1146-1155Article in journal (Refereed)
    Abstract [en]

    STUDY QUESTION: How is the reproductive life plan (RLP) adopted in midwifery contraceptive counselling? SUMMARY ANSWER: A majority of midwives adopted the RLP in their counselling, had predominantly positive experiences and considered it a feasible tool for promoting reproductive health. WHAT IS KNOWN ALREADY: The RLP is a health-promoting tool recommended by the Centers for Disease Control and Prevention in the USA for improving preconception health. It was recently used in a clinical setting in Sweden and was found to increase women's knowledge about fertility and to influence women's wishes to have their last child earlier in life. STUDY DESIGN, SIZE, DURATION: An exploratory mixed methods study among 68 midwives who provided contraceptive counselling in primary health care to at least 20 women each during the study period. Midwives received an introduction and materials for using the RLP in contraceptive counselling. Three months later, in the spring of 2014, they were invited to complete a questionnaire and participate in a focus group interview about their adoption of the RLP. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data collection was through a questionnaire (n = 53 out of 68; participation rate 78%) and five focus group interviews (n = 22). Participants included both younger and older midwives with longer and shorter experiences of contraceptive counselling in public and private health care in one Swedish county. Quantitative data were analysed for differences between users and non-users, and qualitative data were analysed by qualitative content analysis to explore the midwives experiences and opinions of using the RLP. MAIN RESULTS AND THE ROLE OF CHANCE: Sixty-eight per cent of midwives had used the RLP in their contraceptive counselling. Four categories emerged through the focus group interviews: (i) A predominantly positive experience; (ii) The RLP-a health-promoting tool; (iii) individual and societal factors influence the RLP counselling; and (4) long-term implementation comprises opportunities, risks and needs. The most common reason for not using the RLP was lack of information. LIMITATIONS, REASONS FOR CAUTION: There was general lack of experience of using the RLP with women from different cultural backgrounds, with non-Swedish speaking women and, when a partner was present. Due to the non-random sample, the limited knowledge about non-responders and a short follow-up period, results apply to short-term implementations and might not fully apply to long-term implementation. WIDER IMPLICATIONS OF THE FINDINGS: The use of RLP in contraceptive counselling appears a feasible way of promoting reproductive health. Results from the USA and Sweden indicate it is a promising tool for midwives and other health professionals involved in reproductive counselling, which deserves to be explored in other nations.

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  • 99.
    Stern, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Kristiansson, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Introducing reproductive life plan-based information in contraceptive counselling: an RCT2013In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 28, no 9, p. 2450-2461Article in journal (Refereed)
    Abstract [en]

    Can reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy increase womens knowledge of reproduction, and of the importance of folic acid intake in particular? The RLP-based information increased womens knowledge of reproduction including knowledge of folic acid intake. Many women have insufficient knowledge of reproduction, including a health-promoting lifestyle prior to conception, and highly educated women in particular postpone childbearing until an age when their fertile capacity has started to decrease. The study was an randomized controlled trial with one intervention group (IG) and two control groups (CG1, CG2). A sample size calculation indicated that 82 women per group would be adequate. Recruitment took place during 3 months in 2012 and 299 women were included. The women were randomized in blocks of three. All groups received standard care (contraceptive counselling, Chlamydia testing, cervical screening). In addition, women in the IG were given oral and written RLP-based information about reproduction. A total of 299 out of 338 (88) Swedish-speaking women visiting a Student Health Centre were included (mean age 23 years); response rate was 88. Before the counselling, women in the IG and the CG1 completed a baseline questionnaire, including questions about lifestyle changes in connection to pregnancy planning, family planning intentions and knowledge of reproduction (e.g. the fecundity of an ovum). At follow-up 2 months after inclusion, a structured telephone interview was performed in all groups (n 262, 88 participation rate). There was no difference between the groups regarding the mean knowledge score at baseline. The IG scored higher at follow-up than at baseline (P 0.001); the mean increased from 6.4 to 9.0 out of a maximum 20 points. The women in the CG1 scored no differently at follow-up than at baseline. The difference in the knowledge score between the IG and the two CGs was significant (P 0.001), whereas no difference was shown between the two CGs. There was no difference between the groups at baseline regarding how many women could mention folic acid intake among the things to do when planning to get pregnant. At follow-up, 22 in the IG, 3 in CG1 and 1 in CG2 mentioned folic acid intake (P 0.001). At follow-up, more women in the IG also wished to have their last child earlier in life (P 0.001) than at baseline, while there was no difference in the CG1. As the study sample consisted of university students, it is possible that the effect of the intervention was connected to a high level of education and conclusions for all women of reproductive age should be drawn with caution. The provision of RLP-based information seems to be a feasible tool for promoting reproductive health. Study funding was received from the Faculty of Medicine, Uppsala University, Sweden. There are no conflicts of interest. ClinicalTrial.gov Identifier NCT01739101.

  • 100.
    Stern, Jenny
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Implementation and evaluation of the reproductive life plan2012In: 2nd European Congress on Preconception Care and Health Rotterdam 2012: Oral plenary session 4: Preconceptioninterventions, Implementation strategies, Cost effectiveness, InternationalPolicies O4-15, 2012Conference paper (Refereed)
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