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  • 51.
    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.
    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.
    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), International Child Health and Nutrition.
    Contraception use and unplanned pregnancies in a peri-urban area of eSwatini (Swaziland)2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Background: Despite reported high levels of contraception use in eSwatini, unplanned pregnancies are common. The aims of this study were to investigate prevalence and determinants of contraception use and unplanned pregnancies in a disadvantaged area in the Kingdom of eSwatini (Swaziland), and to investigate the association between unplanned pregnancies and antenatal care attendance. Methods: This cross-sectional study was conducted at the non-governmental organization Siphilile Maternal and Child Health in Matsapha, a peri-urban industrial area, using data from pre-existing client records. The sample included clients (n = 1436) registered during pregnancy or up to three months postpartum between August 2014 and April 2016. Contraception use before conception and unplanned pregnancies were analysed with logistic regression to find associations with socio-demographic factors and health care utilization. Results: In this population, 59% (n = 737) stated to have used contraception before becoming pregnant. Teenagers and first-time mothers were less likely to have used contraception. Seventy percent (789/1124) of the pregnancies were unplanned. Older women ( 35 years) were less likely while teenagers and multiparas (>= 3 children) were more likely to have an unplanned pregnancy. Women with unplanned pregnancies were less likely to attend the recommended number of antenatal care visits compared to women with planned pregnancies. Conclusion: The rate of unplanned pregnancies is high in this population, especially among teenagers. Family planning interventions need to focus on preconception care for teenagers to enable pregnancy planning including improved antenatal care attendance.

  • 52.
    Njoroge, Kezia M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Pertet, Ann M.
    Ahlberg, Beth Maina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Voices unheard: Youth and sexuality in the wake of HIV prevention in Kenya2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 4, p. 143-148Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of the study was to explore the concerns of young people on sexuality in its social contexts in the era of HIV/AIDS in three districts in Kenya.

    Study design

    Young people in Kajiado, Kirinyaga and Meru Districts were requested to write questions on sexuality and related problems that later formed the basis for discussion in community dialogue meetings with adults. The social ecological conceptual model (SEM) was used to illuminate the contextual factors and actors influencing sexual behaviours among young people.

    Results

    The study suggests that young people and adults are concerned about honest and open communication on sexuality. Predominant concerns for the young people were love, sexual urge, desires or sexual wellness and condom use. Their questions suggest that young people are sexually active, yet have little knowledge on sexual matters. The results describe a prohibitive silence from adults, an issue reflected in the questions from the school youth.

    Conclusion

    This study suggests the need to move from seeing sexuality as a problem and focus on sexual wellness and the positive aspects of sexuality. The adult participants suggested that bringing men and women together for reflection and discussion in a participatory mode, transformative learning and change could be achieved. It is vital that the youth and adults have open communication as a foundation for youth to mature into adults. This can be achieved, if interventions including research address multiple contextual factors such as cultural norms, gender differences, as well as communication barriers.

  • 53.
    Noren, Josefine
    et al.
    Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Hedberg Nyqvist, Kerstin
    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), Paediatric Inflammation Research.
    Rubertsson, Christine
    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. Lund Univ, Dept Hlth Sci, Lund, Sweden.
    Blomqvist, Ylva Thernström
    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), Perinatal, Neonatal and Pediatric Cardiology Research. Univ Hosp, Neonatal Intens Care Unit, Uppsala, Sweden.
    Becoming a mother: Mothers' experience of Kangaroo Mother Care2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 181-185Article in journal (Refereed)
    Abstract [en]

    Objective: To describe mothers' experiences of providing their preterm infants with Kangaroo Mother Care (KMC).

    Study design: A qualitative descriptive design.

    Setting: Two level III neonatal intensive care units (NICUs) in Sweden.

    Participants: Thirteen mothers of preterm infants.

    Methods: The mothers were interviewed when their infant had reached a corrected age of 4 months +/- 2 weeks. The interviews were recorded and transcribed and data were analyzed using qualitative content analysis.

    Results: The mothers described the skin-to-skin contact with, and closeness to, the preterm infant as something they valued, and involuntary physical separation as something they had to accept and adapt to. Providing the infant with breast milk by expressing and tube feeding was experienced as time-consuming and as impinging on the skin-to-skin contact.

    Conclusion: Mothers want to stay close to their preterm infant. The NICU environment and staff can facilitate KMC by providing a private space for parents and infants, and enable mothers to breastfeed and express breast milk by giving them support based on science and proven experience.

  • 54.
    Olsson, Pia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Wijewardena, Kumudu
    Dept of Community Medicine, Sri Jayawardenepura University, Nugegoda, Sri Lanka.
    Unmarried women’s decisions on pregnancy termination: Qualitative interviews in Colombo, Sri Lanka2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 4, p. 135-141Article in journal (Refereed)
    Abstract [en]

    Background: In Sri Lanka pregnancy termination is very restricted by law and social norms. Premarital sex, and pregnancies are not generally accepted and unmarried pregnant women are vulnerable in their decision-making on pregnancy termination.

    Objectives: The objective of this study was to describe the circumstances of becoming pregnant and factors considered in the decision-making for seeking pregnancy termination in a sample of unmarried women in Colombo, Sri Lanka.

    Methods: Individual qualitative interviews were conducted with 19 unmarried women seeking pregnancy terminations at a reproductive health centre in Colombo, Sri Lanka. The interviews were later analysed using qualitative content analysis.

    Results: Becoming pregnant in a love relationship was predominant in this sample. Awareness of contraceptives varied and initial reaction to the pregnancy involved strong contradictory emotions. Multiple interrelated factors were considered in the decision-making for termination. Family pressure was the most prominent factor followed by the partner’s qualities and attitude towards the pregnancy, economic factors and own feelings, values and future fertility. The women described that their own emotional, religious and economic reasons for continuing the pregnancy were often outweighed by their responsibility to the family, male partner and unborn child.

    Conclusions: These unmarried women’s sexual and reproductive rights were limited and for many the pregnancy termination was socially unsafe. They found themselves at the interface of two value systems. Modern values allow for relationships with men prior to marriage; whereas, traditional values did not. The limited possibilities to prevent pregnancies and little hope for support if continuing the pregnancy; made women seek pregnancy termination despite own doubts.

  • 55.
    Oscarsson, Marie G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Dahlberg, Annica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Tyden, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Midwives at youth clinics attitude to HPV vaccination and their role in cervical cancer prevention2011In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, no 4, p. 137-142Article in journal (Refereed)
    Abstract [en]

    Objective: To explore youth clinic midwives role in cervical cancer prevention and their attitude to HPV vaccination. Study design: Individual interviews with 13 midwives working at youth clinics in Sweden. The interviews were recorded, transcribed, and analysed by qualitative content analysis. Results: Three themes were identified in the qualitative content analysis: "Cervical cancer prevention not a prioritised area", "Ambivalence to the HPV vaccine", and "Gender and socioeconomic controversies". Few midwives talked spontaneously about cervical cancer prevention. The responsibility for providing information about HPV vaccination was considered as primarily that of school health nurses and parents. Midwives were positive about the HPV vaccination, but recognised certain risks, such as its potential negative impact on cervical cancer screening and increased sexual risk taking. The midwives expressed concerns with medical risks, such as side effects and unknown long-term effects of the HPV vaccine. The midwives in the study had ethical concerns that boys were not included in the program and not all families had the financial resources to vaccinate their children. Thus, weak socioeconomic groups might be excluded. Conclusion: The midwives considered cervical cancer prevention as important, but did not integrate information on the HPV vaccine into their routine work, mainly because young people visiting youth clinics had had their sexual debut and they were concerned about the medical risks and that the vaccine was too expensive.

  • 56.
    Oscarsson, Marie G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Hannerfors, Anna-Karin
    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.
    Young women's decision-making process for HPV vaccination2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 4, p. 141-146Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore young women's decision-making process for HPV vaccination and to identify their beliefs about HPV vaccination. Methods: This study employs a qualitative design. Data was collected by audio-taped interviews with 16 HPV vaccinated Swedish women, 17-26 years old. The data was analysed using latent content analysis. Results: Three themes emerged from the data: "Fear of cancer", "Reliance on vaccination" and "Mother the main motivational factor". One of the major reasons for taking the decision to be HPV vaccinated was fear of cancer: vaccination was seen as a way to protect oneself against this. The young women's decision-making surrounding HPV vaccination was based on reliance on vaccination and trust in health care. Support from the mothers of the young women and mothers' sponsorship of costs initiated HPV vaccination. Other motivational factors were advertisements and friends. Despite having been vaccinated, the young women were unaware of the relation between cervical cancer, sexual behaviour and HPV. Conclusion: These HPV vaccinated young women had limited knowledge about HPV. Therefore it is important that health professionals provide comprehensible information about HPV vaccination in attaining informed consent. In order to avoid misunderstandings, health care professionals in youth clinics and schools need to initiate discussion with young women, clarifying the relation between cervical cancer. HPV and sexual transmission.

  • 57. Osman, Hodan Mohamoud
    et al.
    Egal, Jama Ali
    Kiruja, Jonah
    Osman, Fatumo
    Byrskog, Ulrika
    Erlandsson, Kerstin
    Women's experiences of stillbirth in Somaliland: A phenomenological description.2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, p. 107-111, article id S1877-5756(16)30157-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Low- and middle-income countries in Africa have the highest rates of stillbirths in the world today: as such, the stories of the grief of these women who have had a stillbirth in these settings need to be told and the silence on stillbirth needs to be broken. In an attempt to fill this gap, the aim of this study was to describe the experiences of Muslim Somali mothers who have lost their babies at birth.

    METHOD: Qualitative interviews with ten Somali women one to six months after they experienced a stillbirth. Data were analyzed using Giorgi's method of phenomenological description.

    RESULTS: In the analysis, four descriptive structures emerged: "a feeling of alienation"; "altered stability in life"; "immediate pain when the sight of the dead baby turns into a precious memory"; and "a wave of despair eases". Together, these supported the essence: "Balancing feelings of anxiety, fear and worries for one's own health and life by accepting Allah's will and putting one's trust in him".

    CONCLUSIONS: This study makes an important contribution to our knowledge about how stillbirth is experienced by women in Somaliland. This information can be useful when health care providers communicate the experiences of stillbirth to women of Muslim faith who have experienced an intrauterine fatal death (IUFD) resulting in a stillbirth.

  • 58.
    Pallangyo, Eunice N.
    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).
    Mbekenga, Columba
    Muhimbili Univ Hlth & Allied Sci, Sch Nursing, Dept Community Hlth, Dar Es Salaam, Tanzania..
    Källestål, Carina
    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).
    Rubertsson, Christine
    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).
    Olsson, Pia
    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).
    "If really we are committed things can change, starting from us": Healthcare providers' perceptions of postpartum care and its potential for improvement in low-income suburbs in Dar es Salaam, Tanzania2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, p. 7-12Article in journal (Refereed)
    Abstract [en]

    Objective

    To explore healthcare providers' perceptions of the current postpartum care (PPC) practice and its potential for improvement at governmental health institutions in low-resource suburbs in Dar es Salaam, Tanzania.

    Design

    Qualitative design, using focus group discussions (8) and qualitative content analysis.

    Setting

    Healthcare institutions (8) at three levels of governmental healthcare in Ilala and Temeke suburbs, Dar es Salaam.

    Participants

    Registered, enrolled and trained nurse-midwives (42); and medical and clinical officers (13).

    Results

    The healthcare providers perceived that PPC was suboptimal and that they could have prevented maternal deaths. PPC was fragmented at understaffed institutions, lacked guidelines and was organized in a top-down structure of leadership. The participants called for improvement of: organization of space, time, resources, communication and referral system; providers' knowledge; and supervision and feedback. Their motivation to enhance PPC quality was high.

    Key conclusions

    The HCP awareness of the suboptimal quality of PPC, its potential for promoting health and their willingness to engage in improving care are promising for the implementation of interventions to improve quality of care. Provision of guidelines, sensitization of providers to innovate and maximize utilization of existing resources, and supportive supervision and feedback are likely to contribute to the sustainability of any improvement.

  • 59.
    Palm, Anna
    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), Obstetric research.
    Danielsson, Ingela
    Umea Univ, Dept Clin Sci, Obstet & Gynaecol, SE-90187 Umea, Sweden..
    Högberg, Ulf
    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), Obstetric research.
    Norbergh, Karl-Gustav
    Mid Sweden Univ, Fac Human Sci, Dept Nursing Sci, SE-85170 Sundsvall, Sweden..
    How do youth with experience of violence victimization and/or risk drinking perceive routine inquiry about violence and alcohol consumption in Swedish youth clinics?: A qualitative study2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, p. 51-57Article in journal (Refereed)
    Abstract [en]

    Objective: To explore perceptions and experiences among youth who underwent structured questions about violence victimization and alcohol consumption when visiting Swedish youth clinics.

    Methods: This study is part of a larger research project examining the effect of including routine inquiry about violence victimization and alcohol consumption for youth visiting youth clinics. Fifteen youth with experiences of victimization and/or risk drinking (AUDIT-C >= 5) were interviewed. Content analysis was used.

    Results: The findings were grouped into three main categories: The first; "Disclosure talking about violence" reflected the participants' experiences of being asked about victimization. Participants were in favor of routine inquiry about violence victimization, even when questions caused distress. The questions helped participants reflect on prior victimization and process what had happened to them. The second; "Influence on the life situation" demonstrated that many of the participants still were effected by prior victimization, but also how talking about violence sometimes led to the possibility of initiating change such as leaving a destructive relationship or starting therapy. In the third; "One's own alcohol consumption in black and white" participants considered it natural to be asked about alcohol consumption. However, most participants did not consider their drinking problematic, even when told they exceeded guidelines. They viewed risk drinking in terms of immediate consequences rather than in quantity or frequency of alcohol intake.

    Conclusion: Routine inquiry about violence victimization and risk drinking at youth clinics was well received. Questions about violence helped participants to interpret and process prior victimization and sometimes initiated change.

  • 60.
    Rassjo, Eva Britta
    et al.
    Department of Obstetrics and Gynaecology, Falun Hospital, Sweden.
    Byrskog, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Samir, Raghad
    Department of Obstetrics and Gynaecology, Falun Hospital, Sweden.
    Klingberg-Allvin, Marie
    Department of Women’s and Children’s Health, Karolinska Institutet, Sweden.
    Somali women's use of maternity health services and the outcome of their pregnancies: A descriptive study comparing Somali immigrants with native-born Swedish women2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 3, p. 99-106Article in journal (Refereed)
    Abstract [en]

    Objectives: To describe how Somali immigrant women in a Swedish county use the antenatal care and health services, their reported and observed health problems and the outcome of their pregnancies. Study design: Retrospective, case-control study, comparing data obtained from the records of antenatal and obstetric care for Somali born women with the same data for parity matched women born in Sweden giving birth between 2001 and 2009. Main outcome measures: Utilisation of antenatal health care (timing and number of visits), pregnancy complications (severe hyperemesis, anaemia, preeclampsia), mode of birth (normal vaginal, operative vaginal, caesarean), and infant outcomes (preterm birth, birth weight, and perinatal mortality). Results: Compared to the 523 Swedish-born women tM 262 Somali women booked later and made less visits for antenatal care. They were more likely to have anaemia, severe hyperemesis and a few patients were found to have very serious health conditions. Emergency caesarean section (OR 1.90, CI 1.16-3.10), especially before start of labour (OR 4.96, CI 1.73-14.22), high perinatal mortality with seven versus one perinatal deaths and small for date infants (OR 2.95, CI 1.49-5.82) was also more prevalent. Conclusion: Pregnant Somali immigrant women still constitute a vulnerable group, which implicates that there is a missing link in the surveillance system that needs attention. There is an increased risk for intrauterine foetal death, small for date and low birth weight infants as well as serious maternal morbidity.

  • 61.
    Råssjö, Eva-Britta
    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).
    Kiwanuka, Robert
    Centre for Clinical Research, Falun, Sweden.
    Views on social and cultural influence on sexuality and sexual health in groups of Ugandan adolescents2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 4, p. 157-162Article in journal (Refereed)
    Abstract [en]

    Sexual problems such as forced and transactional sex are common among adolescents, especially in developing countries. The objective of the present study was to describe how young people respond to their social living conditions and why they marry early, have early pregnancies, experience forced sex and involve themselves in transactional sex. Young people, 15-24 years old, participated in focus group discussions that were tape recorded, translated into English, transcribed and analysed by qualitative content analysis. Six groups were mixed, with both women and men, while two groups had only men and one group only women as participants. The two study sites were located in a slum area in Kampala and in a village in Wakiso district, near a trading centre. The following topics were discussed: Forced sex, early marriage, contraception, teenage pregnancy and transactional sex. The participants described how young people are affected by harmful cultural practices, by power imbalance, especially due to gender-based inequity, and by lack of information and life skills. This study also showed that young people perceive themselves as a resource and are prepared to help other less advantaged youth to get knowledge about reproductive health issues. Enforcement of laws that can protect children and youth was suggested. Government and community should work against harmful traditional practices and introduce sexual education in primary school.

  • 62.
    Saulo, Bryson
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Walakira, Eddy
    Department of Social Work and Social Administration, Faculty of Social Sciences, Makerere University, Kampala, Uganda.
    Darj, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Access to healthcare for disabled persons: How are blind people reached by HIV services?2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 1, p. 49-53Article in journal (Refereed)
    Abstract [en]

    Disabled people are overlooked and marginalised globally. There is a lack of information on blind people and HIV-related services and it is unclear how HIV-services target blind people in a sub-Saharan urban setting.

    OBJECTIVE:

    To explore how blind people are reached by HIV-services in Kampala, Uganda.

    METHOD:

    A purposeful sample of blind people and seeing healthcare workers were interviewed, and data on their opinions and experiences were collected. The data were analysed by qualitative content analysis, with a focus on manifest content.

    RESULTS:

    Three categories emerged from the study, reaching for HIV information and knowledge, lack of services, and experiences of discrimination. General knowledge on HIV prevention/transmission methods was good; however, there was scepticism about condom use. Blind people mainly relied on others for accessing HIV information, and a lack of special services for blind people to be able to test for HIV was expressed. The health service for blind people was considered inadequate, unequal and discriminatory, and harassment by healthcare staff was expressed, but not sexual abuse. Concerns about disclosure of personal medical information were revealed.

    CONCLUSION:

    Access to HIV services and other healthcare related services for blind people is limited and the objectives of the National Strategic Plan for HIV/AIDS 2007-2012 have not been achieved. There is a need for alternative methods for sensitisation and voluntary counselling and testing (VCT) for blind people.

  • 63.
    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.

  • 64. Soderberg, Malin
    et al.
    Christensson, Kyllike
    Lundgren, Ingela
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Women's attitudes towards fertility and childbearing - A study based on a national sample of Swedish women validating the Attitudes to Fertility and Childbearing Scale (AFCS)2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 2, p. 54-58Article in journal (Refereed)
    Abstract [en]

    Objective: A delay in childbearing has been reported in high-resource countries. Factors reported to impact postponement include being mature enough, completing studies, and receiving a good salary. Other reasons are the partner relationship, efficient forms of contraception, value changes, housing conditions, and economic uncertainty. The aim of the study was to validate the previously developed instrument Attitudes to Fertility and Childbearing Scale (AFCS) in a sample of Swedish women and to relate the components to the women's socio-demographic characteristics. Methods: Four hundred and twenty-four women, 20-30 years of age, who were not mothers answered and returned the questionnaire. Statistical analysis was conducted; construct validity using principal comwomen's background characteristics. ponent analysis (PCA), Student's t-test, and ANOVA was performed between the three components and women's background characteristics. Results: The two components with highest loadings were Importance for future and Hindrance at present, indicating a time conflict. The third component was Female identity. The youngest women, single women, students, and women living in large cities were more likely to score high with the component Hindrance at present. Women having a partner were more likely to score high on Importance for future and Female identity. Conclusion: In this population, age, occupation, residential area, and civil (marital) status play a role in the attitudes towards fertility and childbearing. Fertility in relation to individual differences and age needs to be informed and discussed in society as well as in sexual and reproductive health care.

  • 65.
    Ternström, Elin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Haines, Helen
    Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Sundin, Örjan
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Ekdahl, Johanna
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Segebladh, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Sundsvall Hosp, Res & Dev Ctr, Sundsvall, Sweden..
    Rondung, Elisabet
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth: A study protocol2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, p. 75-82Article in journal (Refereed)
    Abstract [en]

    Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

  • 66.
    Thitasan, Anchalee
    et al.
    Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden; Boromarajonani Coll Nursing, Sunpasithiprasong, Thailand.
    Aytar, Osman
    Mälardalen Univ, Sch Hlth Care & Social Welf, Eskilstuna, Sweden.
    Annerbäck, Eva-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Velandia, Marianne
    Mälardalen Univ, Sch Hlth Care & Social Welf, Västerås, Sweden.
    Young people's health and risk behaviours in relation to their sexual orientation: A cross-sectional study of Thailand and Sweden2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, p. 67-74, article id S1877-5756(18)30291-XArticle in journal (Refereed)
    Abstract [en]

    Objectives: This study examined the associations between sexual orientation of young people and their health and risk behaviours in Thailand and Sweden, and to explore similarities and differences between the countries.

    Study design: A cross-sectional study using data from the Life and Health – Young surveys in Thailand and Sweden. Three different statistical analyses were used to examine the associations of the variables.

    Results: In total, 3869 students aged 16–18 years old were included: 1488 Thai students and 2381 Swedish students. Significantly more Thai (20%) than Swedish (9%) students identified themselves as bisexual, homosexual or unsure (p < .001). Bivariate analysis showed that, in Thailand, self-harm was more often reported by the homosexual, unsure, and bisexual groups than by the heterosexual group (p = .005). In Sweden, early sexual debut was more often reported by the unsure, bisexual, and homosexual groups than by the heterosexual group (p = .033). Multiple logistic regression analysis showed that homosexual and unsure sexual orientations were significantly associated with self-harm (p < .05) among Thai students. Unsure sexual orientation was significantly associated with early sexual debut (p = .04) among Swedish students. Multiple correspondence analysis indicated that sexual orientation was associated with health and risk behaviours, and varied by different subcategories of students’ backgrounds such as country, sexual orientation, family structure and adult support.

    Conclusions: Sexual minority young people reported more risk behaviours and poorer health than their heterosexual counterparts. The findings are useful for policy programmes on sexual and reproductive health and rights of young people.

     

  • 67.
    Tinglöf, Soile
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Wallin Lundell, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Exposure to violence among women with unwanted pregnancies is associated with post-traumatic stress disorder, symptoms of anxiety and depression2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 2, p. 50-53Article in journal (Refereed)
    Abstract [en]

    Aim

    The objective was to examine lifetime exposure to violence, physical and sexual, among women seeking termination of pregnancy (TOP) and its association with socio-demographic factors, PTSD, symptoms of anxiety and depression.

    Design

    The design of the study was a Swedish multi-centre study targeting women requesting TOP.

    Methods

    All women requesting TOP with a gestational length less than 12 pregnancy weeks were approached for participation in the study. The questionnaire comprised the following research instruments: Screen Questionnaire-Post traumatic Stress Disorder (SQ-PTSD) and Hospital Anxiety and Depression Scale (HADS). The response rate was 57% and the final sample was 1514 women. Descriptive and analytic statistics were applied.

    Results

    Lifetime exposure to violence was common among women seeking abortion. Exposure to violence was associated with low education, single marital status, smoking and high alcohol consumption. Exposure to violence was associated with the occurrence of signs of PTSD and symptoms of anxiety and depression. Among those having PTSD, all had been exposed to sexual violence and almost all had been exposed to physical violence, while for those with symptoms of anxiety and depression almost half had been exposed to either physical or sexual violence.

    Conclusion

    Exposure to physical and sexual abuse was common among women requesting TOP, and was strongly associated with the occurrence of PTSD, symptoms of anxiety and depression. This underscores the importance for health professionals to recognize and offer support to those women exposed to violence.

  • 68.
    Ugarte, William J.
    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).
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Valladares, Eliette
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Assessing knowledge, attitudes, and behaviors related to HIV and AIDS in Nicaragua: A community-level perspective2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    Background:

    Nicaragua's HIV epidemic is concentrated among men who have sex with men.Nevertheless, the increasing number of HIV cases among heterosexuals, high levels of poverty andmigration rates, and incomplete epidemiological data suggest the need to improve the understanding of the epidemic.

    Objective:

    To examine the prevalence of HIV-related knowledge, attitudes, and sexual rsik-taking behaviors, and their predictors among the adult population.

    Methods:

    A community-based cross-sectional survey was conducted in 2009 among 520 participants ages 15 to 49 from an ongoing Health and Demographic Surveillance System in Nicaragua. Bivariate analysis and adjusted prevalence ratios were use to examine factors associated with HIV-related knowledge, attitudes, and sexual behavior.

    Results:

    Contributing factors for risk-taking behaviors included cognitive, psychosocial, and emotional elements. Insufficient knowledge affecting the accurate assessment of HIV risk were low educational level, poverty, and rural origin, especially among females. Recognizing risk was not sufficient to promote safer sex: 90% of the females and 70% of the males who reported being sexually active in the past year did not use condoms during their last sexual encounter. Inconsistent condom use among men was associated with older age, long-term relationships, and lack of awareness about acquiring HIV infection.

    Conclusions:

    Interventions to reduce social-structural contextual factors in Nicaragua are needed so that individuals may adopt and maintain HIV risk reduction strategies. Increased gender-specific HIV education and skills-building programs need to be implemented. Sensitive mass media messages may also increase the knowledge of HIV and AIDS, and serve to encourage protective attitudes and behaviors.

  • 69. Wiklund, Ingela
    et al.
    Ahlberg, Mia
    Dahlstrom, Anders
    Weichselbraun, Marianne
    Sjörs, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Routine testing of umbilical cord blood after normal delivery should be discontinued2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 4, p. 165-166Article in journal (Refereed)
    Abstract [en]

    On many newborns in Sweden routine samples of blood are taken from the umbilical cord after birth to measure the acid base balance. These tests were introduced with the aim to objectively measure the well-being and stress levels of the newborn. The information was to be used as a measurement of quality of care, for research and as a tool to help guide decisions around the care-needs of the newborn. After 10 years of routine analysis it has become clear that the results of these tests have limited clinical value and that they are a poor measurement of quality of care. 

  • 70.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Andolf, Ellika
    Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Lilja, Håkan
    Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Hildingsson, Ingegerd
    Mid Sweden University, Department of Health Science, Sundsvall, Sweden.
    Indications for cesarean section on maternal request--guidelines for counseling and treatment.2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 3Article in journal (Refereed)
    Abstract [en]

    AIM: The aim was to find scientific evidence and, based on this, to develop national medical guidelines in Sweden for cesarean section on mother's request.

    BACKGROUND: More than 17% of all births in Sweden in 2008 were cesarean sections, compared to 5% at the beginning of the 1970s. About 8% of the cesarean sections were performed at mother's request. The predominant reason for this preference is fear of childbirth. When deciding whether to perform an elective cesarean section, the obstetrician must emphasize the long- and short-term health consequences for the mother and her baby, as well as weigh the risks associated with the procedure itself against not performing the procedure. Clarification is needed to determine for which conditions it is appropriate to comply with the mother's request.

    MATERIALS AND METHOD: A literature review was conducted to identify factors that were relevant as an argument to meet the request for cesarean section on maternal request. The authors analyzed these factors individually to determine.

    FINDINGS: The guidelines suggest that it is appropriate to comply with a woman's request for cesarean section if the reason for her request is deemed sufficiently serious and if, after participating in a counseling program, the woman persists in her request for cesarean section.

    CONCLUSION: A request for cesarean section where no medical indication is present should not be met without considerations concerning the safety of the mother and her baby, while also weighing the risk of adverse outcomes for mother and baby.

  • 71.
    Åhman, Annika
    et al.
    Umea Univ, Dept Clin Sci Obstet & Gynaecol, SE-90187 Umea, Sweden..
    Edvardsson, Kristina
    Umea Univ, Dept Clin Sci Obstet & Gynaecol, SE-90187 Umea, Sweden.;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia..
    Kidanto, Hussein L.
    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). Minist Hlth Social Welf Gender Children & Elderly, Reproduct Maternal & Child Hlth, Dar Es Salaam, Tanzania.
    Ngarina, Matilda
    Muhimbili Natl Hosp, Dept Obstet & Gynaecol, Dar Es Salaam, Tanzania..
    Small, Rhonda
    La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia..
    Mogren, Ingrid
    Umea Univ, Dept Clin Sci Obstet & Gynaecol, SE-90187 Umea, Sweden..
    'Without ultrasound you can't reach the best decision': Midwives' experiences and views of the role of ultrasound in maternity care in Dar Es Salaam, Tanzania2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 28-34Article in journal (Refereed)
    Abstract [en]

    Objective: To explore Tanzanian midwives' experiences and views of the role of obstetric ultrasound in relation to clinical management of pregnancy, and in situations where maternal and fetal health interests conflict.

    Method: In 2015, five focus group discussions were conducted with midwives (N = 31) at three public referral hospitals in the Dar es Salaam region as part of the CROss Country Ultrasound Study (CROCUS).

    Results: Ultrasound was described as decisive for proper management of pregnancy complications. Midwives noted an increasing interest in ultrasound among pregnant women. However, concerns were expressed about the lack of ultrasound equipment and staff capable of skilful operation. Further, counselling regarding medical management was perceived as difficult due to low levels of education among pregnant women.

    Conclusion: Ultrasound has an important role in management of pregnancy complications. However, lack of equipment and shortage of skilled healthcare professionals seem to hamper use of obstetric ultrasound in this particular low-resource setting. Increased availability of obstetric ultrasound seems warranted, but further investments need to be balanced with advanced clinical skills' training as barriers, including power outages and lack of functioning equipment, are likely to continue to limit the provision of pregnancy ultrasound in this setting.

  • 72.
    Åkerman, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Larsson, Elin C.
    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). Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Essén, Birgitta
    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).
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 19, p. 64-70Article in journal (Refereed)
    Abstract [en]

    Objective: Poor sexual and reproductive health (SRH) among immigrant women is often related to limited access,or suboptimal use of healthcare services. This study investigates the knowledge about and use of sexual andreproductive healthcare services among immigrant women in Sweden

    Method: A cross-sectional study of 288 immigrant women. A structured questionnaire was distributed amongimmigrants speaking Arabic, Dari, Somali or English registered at Swedish language schools for immigrants.Data collection took place in 19 strategically selected schools in Sweden. Descriptive statistics, chi-square tests,and logistic regressions were used for the analysis.

    Results: About one-third of the immigrant women reported lack of knowledge of where to go for contraceptivecounselling. Experiencing lack of emotional social support and not having had children was associated with thislack of knowledge. An even higher proportion (56%) lacked knowledge of where to go to be HIV tested, and thiswas associated with not having participated in a health examination. Almost 25% stated that their culture keptthem back from using contraception.

    Conclusion: Lack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrantwomen participating in Swedish language schools for immigrants could be considered as a missed opportunity,as all citizens in Sweden have free access to these services. New health policies and strategies should aim toincrease knowledge of SRH services among immigrants. Swedish language schools could play an important rolein increasing knowledge of SRH-related information as many new immigrants become students during their firstyears in Sweden.

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