Healthcare providers balancing norms and practice : challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study

BACKGROUND: Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE: This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN: We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS: The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS: Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.

La formation d’une identité à l’intersection du genre, de l’ethnie et de la classe : Une analyse intersectionnelle de L’Amant de Marguerite Duras

Dans ce mémoire, nous nous sommes servies d’une méthode thématique pour faire une analyseintersectionnelle de L’Amant de Marguerite Duras. Le but était d’étudier la manière complexedont les différentes structures de domination interagissent l’une avec l’autre dans une sociétécoloniale. L’étude a été concentrée sur la recherche d’une identité personnelle effectuée par leprotagoniste féminin et nous avons voulu savoir comment cette recherche est influencée par lesstructures de genre, d’ethnie et de classe.Notre conclusion est que l’appartenance à la catégorie « blanche et pauvre » donne auprotagoniste un sentiment d’aliénation vis-à-vis de la communauté colonisatrice blanche. Cettealiénation l’aide à s’opposer à certaines normes, par exemple le manque de liberté sociale etsexuelle de la femme, en même temps que son comportement peut parfois être interprété commeune confirmation des rôles racistes existant dans la colonie. Néanmoins, nous voulons soulignerque c’est la façon dont l’amant chinois a été décrit qui est troublante, plutôt que lecomportement du protagoniste féminin.

Arbetsmiljö : Med fokus ur ett könsperspektiv

För att åstadkomma en god arbetsmiljö ska arbetsgivaren och arbetstagaren gemensamt sam-verka enligt Arbetsmiljölagen. Därav ligger ansvaret både på arbetsgivaren och arbetstagaren (Arbetsmiljölagen). Denna studie har utförts på ett industriföretag med syfte att undersöka ar-betsmiljön och arbetsskador ur ett kön- och genusperspektiv. För att kunna uppnå ett trovärdigt och tillförlitligt resultat har tre olika metoder använts såsom intervjuer, deltagande observation och information från företagets IA-system. Resultatet visar att det inte finns lika stora skillnader mellan kvinnor och män idag som det gjorde för 15 år sedan. Någonting annat som upptäcktes var att det finns ett stort mörkertal när det gäller att rapportera in säkerhetssamtal, tillbud och olycksfall i företagets IA-system. Efter att ha analyserat det insamlade empiriska materialet blev slutsatsen att kvinnor inte får arbetsskador lättare än män, utan att det beror på de kulturer, normer och värderingar som finns inom industrin. Företaget arbetar på rätt sätt när det gäller säkerhet, utrustning, ergonomi med mera, men når ändå inte ända fram till medarbetarna. Stu-dien visar att en stor del till att arbetsmiljön har blivit skapad på detta sätt genom att det finns en konflikt mellan medarbetare och ledning. Kultur, norm och värderingar påverkar både ar-betssituationen och arbetsmiljön. För att lyckas med sitt arbetsmiljöarbete måste företaget ar-beta med sin kultur och lösa konflikten mellan medarbetare och ledning, vilket kommer att bidrar till nöjdare medarbetare och ett trivsammare klimat.

Pregnant Adolescents in Vietnam : Social context and health care needs

Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people’s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents’ experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers’ perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ‘being in the hands of others’ in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.

Tough, sensitive and sincere : how adolescent boys manage masculinities and emotions

This study aimed to explore adolescent boys’ views of masculinity and emotion management and their potential effects on well-being. Interviews with 33 adolescent boys aged 16–17 years in Sweden were analysed using grounded theory. We found two main categories of masculine conceptions in adolescent boys: gender-normative masculinity with emphasis on group-based values, and non-gender-normative masculinity based on personal values. Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite their expressions contrasting each other. Non-gender-normative masculinity included an orientation towards sincerity emphasising the personal values of the boys; emotions were expressed more independently of peer group norms. Our findings suggest that different masculinities and the expression of emotions are strongly intertwined and that managing emotions is vital for well-being.

Perceptions of the role of the man in family planning, during pregnancy and childbirth : A qualitative study with fifteen Nepali men

Introduction: In Nepal, by tradition, family life and marriage are generally controlled by patriarchal norms, sanctions, values and gender differences. Women in Nepal have limited possibilities to make decisions regarding their sexual and reproductive health, as the husbands and other elders in the family make most of the decisions regarding family planning, pregnancy and childbirth. Aim: To describe the perceptions of Nepali men regarding the role of the man with respect to family planning, pregnancy and childbirth. Methods: A qualitative study was conducted with 15 Nepali men in both urban and rural areas. The material was analyzed through inductive content analysis. Findings: One main category and two generic categories were identified. One generic category contained six subcategories and the other five subcategories. The main category was labeled: “He leads – She follows” and the generic categories were labeled: “Supporting women in family planning, during pregnancy and childbirth” and “Withdrawal from supporting women in family planning, during pregnancy and childbirth”. Conclusion: The role of the Nepali men with respect to family planning, pregnancy and childbirth, was identified as a conflicted approach. This study highlights the importance of understanding the influence of culture and tradition when developing strategies for promoting sexual and reproductive health during family planning, pregnancy and childbirth among families in Nepal.

Adolescent boys’ health : managing emotions, masculinities and subjective social status

The health of adolescent boys is complex and surprisingly little is known about how adolescent boys perceive, conceptualise and experience their health. Thus, the overall aim of this thesis was to explore adolescent boys’ perceptions and experiences of health, emotions, masculinity and subjective social status (SSS). This thesis consists of a qualitative, a quantitative and a mixed methods study. The qualitative study aimed to explore how adolescent boys understand the concept of health and what they find important for its achievement. Furthermore, the adolescent boys’ views of masculinity, emotion management and their potential effects on wellbeing were explored. For this purpose, individual interviews were conducted with 33 adolescent boys aged 16-17 years. The quantitative study aimed to investigate the associations between pride, shame and health in adolescence. Data were collected through a cross-sectional postal survey with 705 adolescents. The purpose of the mixed methods study was to investigate associations between SSS in school, socioeconomic status (SES) and self-rated health (SRH), and to explore the concept of SSS in school. Cross-sectional data were combined with interview data in which the meaning of SSS was further explored. Individual interviews with 35 adolescents aged 17-18 years were conducted. In the qualitative study, data were analysed using Grounded Theory. In the quantitative study, statistical analyses (e.g., chi-square test and uni- and multivariable logistic regression analyses) were performed. In the mixed method study, a combination of statistical analyses and thematic network analysis was applied. The results showed that there was a complexity in how the adolescent boys viewed, experienced, dealt with and valued health. On a conceptual level, they perceived health as holistic but when dealing with difficult emotions, they were prone to separate the body from the mind. Thus, the adolescent boys experienced a difference between health as a concept and health as an experience (paper I). Concerning emotional orientation in masculinity, two main categories of masculine conceptions were identified: a gender-normative masculinity and a non-gender-normative masculinity (paper II). Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite that their expressions are in contrast to each other. Non-gender-normative masculinity included an orientation towards sincerity, emphasising the personal values of the boys. Emotions were expressed more independently of peer group norms. The findings suggest that different masculinities and the expression of emotions are intricately intertwined and that managing emotions is vital for wellbeing. The present findings also showed that both shame and pride were significantly associated with SRH, and furthermore, that there seems to be a protective effect of experiencing pride for health (paper III). The results also demonstrated that SSS is strongly related to SRH, and high SRH is related to high SSS, and further that the positioning was done in a gendered space (paper IV). Results from all studies suggest that the emotional and relational aspects, as well as perceived SSS, were strongly related to SRH. Positive emotions, trustful relationships and having a sense of belonging were important factors for health and pride was an important emotion protecting health. Physical health, on the other hand, had a more subordinated value, but the body was experienced as an important tool to achieve health. Even though health was mainly perceived in a holistic manner by the boys, there were boys who were prone to dichotomise the health experience into a mind-body dualism when having to deal with difficult emotions. In conclusion, this thesis demonstrates that young, masculine health is largely experienced through emotions and relationships between individuals and their contexts affected by gendered practices. Health is to feel and function well in mind and body and to have trusting relationships. The results support theories on health as a social construction of interconnected processes. Having confidence in self-esteem, access to trustful relationships and the courage to resist traditional masculine norms while still reinforcing and maintaining social status are all conducive to good health. Researchers as well as professionals need to consider the complexity of adolescent boys’ health in which norms, values, relationships and gender form its social determinants. Those working with young boys should encourage them to integrate physical, social and emotional aspects of health into an interconnected and holistic experience.

Equal Couples in Equal Houses : Cultural perspectives on Swedish solar and bio-pellet heating design

Knowing how to design a heating system that will work mechanically is quite different from knowling how to design a system that users perceive as responsive to their domestic practices and values. In this chapter, social anthropologist Henning argues that the challenge for designers involved in the development or marketing of green buildings with heating systems that are based on renewable sources of energy is to see things from the perspective of those who are supposed to live in these buildings. The chapter focuses on three culture-specific aspects of Swedish households and single-family houses: perceptions of house and home, of private and public space, and of male and female space. Through these three angles, some clues are given as to how design, performance and location of solar and bio-pellet heating systems could be made to resonate with predominant experiences, habits and ways of thinking among both men and women.

Svensklärares arbete : om villkor för gymnasieskolans svenskämne

The aim of this didactic study is to understand the terms of work, education and teaching of Swedish in a period round 2000. The research questions focus on how teachers at upper secondary school in conversations describe and construct their work, values in society and school, structures of power and relation to time. With the help of tools related to story and storytelling, and by connecting the empirical material to a late modern society, I caninterpret and understand the description of their work. With the help of Pierre Bourdieu’s theory I can see how values, power and relation to time are expressed in different ways when teachers of Swedish talk about their work and education.The results show that when teacher talk about work in school is it related to ideals in a global economy. Decentralization and individualization get new meanings when those words are placed in school environment and activity. Effectiveness, flexibility and individualization are words related to economy and they seem to have an effect on education and subjects of Swedish. I can also understand teachers’ work when it is related to power and values on the educational field. I can see how a diffuse power acts on the field and how harmony is a dominant value and a term that influences teachers’ work. New terms also form new identities related to teaching. New terms form new subjects of Swedish that in time and practice will form newhabitus connected to subjects. I call it ämneskonceptionella habitus.

Organisationer, ojämlikhet, migration : förändringar av den etniska arbetsdelningen i svensk byggnadssektor

Organizations, Inequality, Migration – Changes of the Ethnic Division of Labour in the Swedish Construction Sector During the 1990s the number of migrants from Eastern Europe increased in the Swedish construction sector. This article examines how this change was initiated by changes in the organizational population in the construction sector. The gradual enlargement of the European Union changed the institutional framework for organizations in Sweden. This created increased opportunities for new organizational forms in the construction sector. The specific niche of the new organizations was to recruit and hire out workers from Eastern Europe that were paid lower wages than Swedish workers. The diffusion of this organizational form contributed to a change of norms and beliefs about what was legitimate and illegitimate when employing migrants. This implies that the inequalities that this organizational form introduces have gained increased legitimacy in Sweden. Or in other words, it has become increasingly socially acceptable to pay migrants lower wages than Swedish workers

The attractiveness of the work is affected when production of handcrafted log houses moves indoors

Viewed from a historical perspective, a shift has occurred within the forestry and wood sector towards indoor work. In Sweden, the production of handcrafted log houses has now also begun to move indoors. With a point of departure in development processes within the log house sector involving working indoors, education, work attractiveness, between 2001-2005, the aim of this study was to compare indoor work with outdoor work, based on log house builders' experience of working on handcrafted log houses. Methods used in the interactive development project involving apprentices, experienced log house builders and researchers, were participation with continuous documentation of experiences and opinions; questions; interviews; and measurement of the work environment. The Attractive Work Model has been used in order to analyse perceptions and values. The changes, 15 out of 22 areas, were perceived both negatively and positively. Therefore, it can not be said that working on traditional, handcrafted log houses becomes more attractive if it is moved indoors. The majority wanted to work both outdoors and indoors, while most of the others only wanted to work outdoors. The results indicate that there is scope for developing more attractive work indoors by utilising experiences from log house builders and closely related activities such as the forestry and wood sector. Changes made within one area of work attractiveness affect other areas. Further research is needed both with regard to comparisons between indoor and outdoor work and regarding the interaction between the areas that are identified in the Attractive Work Model.

Arbetsintroduktion - Upplevelser och möjligheter : En undersökning ur tre olika perspektiv

Studier från Amerika och Storbritannien visar att introduktionsprocesser fokuserar för mycket påprocesser, policys och värderingar och mindre på de nyanställdas upplevelser när det gäller stress,stöd till att knyta kontakter med medarbetare och otydliga arbetsbeskrivningar (Andersson, N. R,Cunningham-Snell, N. A. & Haigh, J., 1996 & Klubnik, J. P., 1987).En kvalitativ undersökning har utförts på AniCura Falu Djursjukhus. Undersökningen har genomförtsmed hjälp av intervjuer och mailkonversationer. Syftet med undersökningen är att utforska omde tidigare studierna överensstämmer med upplevelser som nyanställdas på AniCura Falu Djursjukhushar kring arbetsintroduktionen och dess påverkan angående stress, möjligheter till stöd och arbetsbeskrivningar.Nio respondenter med olika ansvarsområden deltog. Resultatet från undersökningenbekräftade att empirin överensstämde med studierna. Exempelvis fick de nyanställda självaansvara för att lära känna sina medarbetare. Undersökningen visade också att organisationen intehade någon strategi för att hantera nyanställdas stress. Det förekom heller ingen återkopplingen påintroduktionen.Undersökningsresultaten kommer i detta arbete diskuteras, analyseras och ställas mot en relevantteoretisk referensram med avseende på de aktuella ämnena för undersökningen. Slutprodukten är ettförbättringsförslag som kan ligga till grund för framtida introduktionsprocesser och vidare forskning.

Emotioner och värdegrundsarbete : Om lärare, fostran och elever i en mångkulturell skola

This thesis explores aspects of teachers’ obligation to implement and discuss what are referred to in the Swedish national school curricula as “fundamental values” (“värdegrunden” in Swedish). The aim is to describe and analyze dilemmas in interpretations of and teachers’ work with these fundamental values. Four questions are related to this aim. The first addresses difficulties discussed in conversations between seven upper secondary teachers, during nine meetings over the course of one year. In these conversations the teachers reflected upon how to interpret the fundamental values in relation to their daily practice. The second question focuses on the considerable diversity of Swedish schools and examines the work of the teachers through a perspective of intersectionality. The third question concerns how Martha Nussbaum’s theory of emotions as judgments of value could be used for an understanding of the identified dilemmas. The fourth question focuses on ways in which the participating teachers’ discussions may contribute to a wider discussion about possible aims and circumstances of teachers’ work with the fundamental values. Chapter 2 introduces the theoretical framework of the study, Martha Nussbaum’s (2001) ethical thinking on emotions as judgments of value. She argues that emotions have four common cognitive components. They have (1) external objects, and are directed towards these objects. They are (2) intentional, reflecting a person’s particular point of view, his or her special way of beholding the object, and (3) consist of judgments, i.e. views of how things in the world are. According to Nussbaum’s Aristotelian ethics, emotions also (4) mirror the individual’s vision of what a good human life is like, and the vulnerability of it. The concept of eudaimonia, a fulfilled or flourishing life, is central. Chapter 3 focuses on ideas of ethnicity, and on the specific obligation mentioned in the curriculum of counteracting xenophobia and intolerance in a multicultural society. Chapter 4 discusses various aspects of the teachers’ thoughts on religiosity within Swedish society (often depicted as one of most secular in the world) and within the educational system that is non-denominational. Chapter 5 draws attention to different ways in which the teachers view and teach pupils about sexual orientation. Chapter 6 presents conclusions on potential advantages of and challenges involved in Nussbaum’s Aristotelian theory of emotions, when applied to teachers’ views of and practical work with the fundamental values described in the curriculum. One advantage is that emotions may be intellectually scrutinized and morally assessed, on grounds that are known beforehand and discussed in a democratic process. The non-productive division between emotions, on the one hand, and intellectual and moral capabilities, on the other, is transcended by Nussbaum’s theory. An important challenge is to reflect upon when to discuss the cognitive content of pupils’ emotions, and when it is appropriate to state what is right or wrong, and try to influence pupils accordingly. Keywords: Emotions, vulnerability, values education, religious education, teaching, Martha Nussbaum, ethnicity, religion, sexual orientation.